There may not be life on other planets, but there WAS life before dentistry.
It was the mid-70’s and I had relatively recently swapped from being a newspaper reporter, to being a press photographer. In those days, we were called press photographers – not members of the paparazzi. ‘Photojournalist’ would have been a little too grand for what I did, which was take pictures for a small weekly newspaper roughly located in the middle of England. I say ‘small’ – by today’s standards, a weekly circulation of 50,000 for a weekly newspaper is pretty stellar, but the ‘news’ we covered was pretty mundane – mainly school sports days and golden wedding couples. Occasionally, a grisly murder would make things interesting, but in the main, the pictures I was sent out to take didn’t grab me. In those days I was only focussed on qualifying as a press photographer through the National Council For The Training Of Journalists and making it to Fleet Street.
It was mid-December (around 1975) and I had slipped into the editorial room to look at the diary and note down what assignments (we called them ‘jobs’) I had to do for the day. I was just thinking “Not another bloody school nativity dress rehearsal” when I overheard one of our reporters (who later went on to be the chief reporter of a national daily newspaper) taking a call from a member of the public who was claiming he had seen an unidentified flying object the night previously. That got me thinking….
That afternoon, I drove ten miles or so to the school to take the nativity pictures and on the way back to the office, I stopped my car overlooking a local landmark. In those days we used black and white film only for the paper and it was difficult to manipulate images like we can these days with Photoshop. I tore a roughly disc-shaped piece of newsprint off the top of my newspaper, stuck it on the windscreen of the car with a bit of spit and focussing on the landmark took three pictures, moving the disc of paper across the screen. I then found a phone box (we were about twenty years off the eplosion of mobile phones) and called the editorial department, telling the news desk I had photographed a UFO. Although it was deadline day, I refrained from shouting down the phone “Hold the front page,” but the editor did just that.
I got back to the office and found that all the reporters were on the phones to the police, the local airports, the Met Office and anyone who would know if there had been ET flying over the town.
I processed the film and produced three prints ready for the editor to see. He was impressed. Although the pictures were (deliberately) blurry, they were as convincing a representative of the typically blurry 70’s UFO pictures that were in vogue in those days. There were no questions as to whether they were genuine or not from my colleagues. I was chuffed they looked so convincing.
The following day, the pictures were published on the front page and they caused quite a stir, a number of people writing in to say they saw the object at the same time as me. I wouldn’t have dismissed these reports out of hand since my idea had been sparked by the man who rang in about a ‘genuine’ sighting.
Things went quiet for a few days until the editor received a call from the Ministry of Defence, demanding my negatives for analysis. I confess that at that point, I was bricking it more than a little. The next day, two military types, one in uniform and with a briefcase handcuffed to his arm, took the negatives without word. If you ever read or hear that the MOD didn’t take UFO’s seriously, think again.
A week or so later I was commanded to go down to bland offices in Birmingham, where I had to give a report of my sighting. By this time I was into it up to my neck and I couldn’t back down. I was in fear of losing my job by that time. Anyway I sat in front of about ten civil servants giving as thorough a description of the flying object as I could. “Oh it was probably about the size of a double-decker bus and it gave out a low hum,” that sort of thing.
All went quiet for a couple of months when I answered the door at my home to a researcher from Panorama who wanted to interview me. I refused point blank. The researcher was an assistant to a household name and I confess, I was beginning to feel hunted.
Things settled. The MOD didn’t issue an arrest warrant for fraud and I was rather pleased that my technique had fooled them.
Years went by, I was offered a job on a National Newspaper, but for some stupid reason turned it down, decided instead, to go to dental school.
Fast forward to the 2000’s and my dental practice manager took a call one afternoon from a retired police chief inspector. He had apparently been trying to track me down since 1975. He believed my pictures were the most convincing he’d seen taken over the county. I had to let him down. He was crushed, but he believed that a number of police officers had reported being abducted during night patrols in the area.
My national reporter friend was the only person who I told that tale to at the time and he kept mum for a number of years, until one day he blabbed. The tale spread throughout the local journalistic fraternity and I must admit, I basked in the kudos.
Ironically, I do truly believe in UFO’s, but up to now, I haven’t been lucky enough to see one myself. I was heartened to see recently that the US Congress is now holding public Oversight Committee hearings into the whole Unidentified Aerial Phenomena business at long last. It’s good to see they’re taking it seriously, though I can personally attest that in 1975, the UK Government was as well, though they didn’t admit it.
I had just qualified as a dentist. In the late 1980’s, if you wanted to become a general dental practitioner (GDP), it wasn’t compulsory to go into vocational training and against all the advice I received, I applied for a couple of part-time jobs in branch practices where for much of the time I would be pretty much left to my own devices. I had a bit of confidence back in those days, having qualified at the ripe old age of 35 and figuring I could handle it, having trooped off to the Royal College of Surgeons and gained LDSRCS before my BDS, just to prove that the latter wasn’t a fluke.
Paddy seemed a pretty laid-back practitioner. He was probably in his late forties and had bought the single-handed Black Country practice a couple of years previously, running it as a branch practice to the surgery he owned in nearby a nearby town. He was looking for a new associate to work the surgery on the two days he wasn’t there. His previous associate had, in his words “Fled to Australia.”
The practice wasn’t the most salubrious I’d ever seen, but the staff and Paddy seemed very pleasant, so I went for it. Paddy assured me that he was on the end of the phone any time I felt the need to pick his brains. I suppose in hindsight I should have taken notice of Paddy’s broad Brummie statement halfway through the interview that he wasn’t that wasn’t ‘into’ dentistry, but preferred DIY. He delivered the ‘Y’ in “DIY” as the Brummie ‘Woy’ (‘o’ as in ‘boy’).
I should have taken that as a portent really, because his DIY wasn’t up to much. He had decided to carry out all the building work he felt he needed to do on the new practice himself. I had erroneously assumed he had only just started his refurbishment.
How I Wish I’d Listened To Advice
I threw myself into the job with gusto and was amazed at the amount of work patients required. Almost all of the adults had deficient amalgams, with most occlusals and class II fillings being at least 1-1.5mm short of the occlusal surface. When I took bitewings, I saw ledges the size of Milton Keynes and there appeared to be no spaces between the teeth. All over the place you could see amalgam trying to escape interproximally. There was a lot of treatment planning to do.
After a couple of weeks I had my first treatments booked in. On one patient I removed a couple of defective MOD’s and lined them (yes, we used to line them in those days). I asked my nurse for a wide matrix band.
She said “Matrix band?”
Turned out, neither of the two practices Paddy owned had matrix bands available. The nurse later told me that Paddy always kept fillings deliberately short of the occlusal surface. She couldn’t remember the last time he had used a carver to shape an amalgam. He reckoned that the way he did them, it saved on articulating paper….and carvers.
There’s More
The next bugbear was the lack of a light-curing unit. Fair enough, light-curing and bonding had only relatively recently become the vogue – up until that point we used a two-paste self-curing system. The name ‘Concise’ flips into the back of my head for some reason. Anyway, if I needed to do a composite, I had to book the light-cure two weeks in advance – there being only one unit available in the main Wolverhampton practice.
When I was first interviewed, the surgery I would be using was not operational and so I was unaware until I started work, that the patient chair, although it reclined, was not powered. This meant that in order to get the patient in the right operational position, you had to physically lift the patient’s back up or down and try not to make an ‘old man getting out of a low settee noise,’ as you did it. One late Friday, a patient came in for an exam. As I hauled him back, a pound coin fell out of his pocket and rolled tortuously slowly across the floor till it fell straight through a hole in the surgery flooring into the cellar below. (Paddy had apparently been DIY-ing on it).
Paddy’s wife was the practice manager of both of his emporia and my mortified nurse rang Paddy’s wife at the main practice, to ask if she could refund the man a pound from petty cash. The PM said “No. Take the patient’s name and tell him we’ll refund him his pound when we take the floorboards up!”
I lasted roughly four months at Paddy’s place.
Lady GA GA
When I was given the tour around the practice at my interview, I had been shown Paddy’s pride and joy, a mobile anaesthetic machine. I was a little confused that there appeared to be no evidence that he used any sort of induction agent from the GA cart, since the only gases I could see were oxygen and nitrous oxide. He reassured me that he had done ‘thousands’ of child GA’s over the years and to feel free to refer any children that needed general anaesthetic extractions to him. Not being a fan of GA extractions in general practice, I quietly referred any children in need of such treatment (there were a LOT of them) to the local hospital GA service.
One day, I saw a child who had infection after an extraction of a six. The tooth had been removed a few days earlier and I asked mum how she got on at the hospital. “Hospital?” she replied. “Mr Power took the tooth out.”
It turned out that Paddy’s wife had been opening my referral letters and getting the patient in so that Paddy could do it himself – as operator and anaesthetist. A nurse later told me that he used the ‘blue gas’ at 100% until the kids passed out, pulled the teeth at speed then put them straight on the oxygen. He was basically suffocating the children with pure nitrous oxide – no recognised induction agent being available.
Paddy ceased GA extractions immediately after I went ballistic at him, for opening my referrals and making all sorts of threats. Unsurprisingly, he accepted my notice without insisting that I served the full three months. I don’t know whether he started doing GA’s again after I left.
What Were The RDO’s Doing?
After a few months, I bumped into my ex-nurse. She said that early one busy surgery morning, Paddy started to experience profound chest pain. An ambulance was called and he was carted off to the local A&E with a suspected heart attack. An hour or so later, Paddy’s wife rang the practice and told the nurses: “Don’t cancel the afternoon. I’ll see how he goes.” She actually intended getting him back to work after having chest pain that indicated he might be experiencing a cardiac event. Fortunately, Paddy survived.
“I should have sniffed trouble when she asked me to reduce the practice sale price by £3.50 after we sold a packet of TePe’s on the day the sale was finalised.”
Anonymous Dentist, 2015
Brace yourselves. For as Spike famously said in Richard Curtis’s Notting Hill, “I’m going to tell you a story that will make your balls shrink to the size of raisins.”
Unfortunately, the tale I am about to tell is true and the dentist involved hopes the gruesome detail therein will serve as a costly reminder to colleagues that as dental professionals we have to dot every ‘T’ and cross every ‘I’ in EVERYTHING we do, or before you know it, the sharks will be circling at the mere sniff of a missing radiographic report. All the events in this story happened. Only the names and the precise Northern location will not be revealed in this piece, although the practitioner/victim willingly sings like a canary when speaking openly to colleagues in her NHS Area. Look away now if you are of a nervous disposition. Some of the detail is graphic and you may find it distressing…..
Background
Anna qualified in the late 1980’s and after six year’s as an associate in general practice she bought an existing general dental practice from a retiring practitioner (Nigel) in a small rural town. Her predecessor had built up a respectable list of patients from a squat set up about 1980 and she was pleasantly surprised that patients seemed to accept her and she lost very few of Nigel’s old faithfuls when she took over. The practice soon grew having been followed by a large number of patients from her previous practice (with the blessing of her previous bosses, who had decided to close the NHS side of their business down).
Anna sat in this practice for nearly 20 years, employing over the years, two part-time associates and a loyal staff that didn’t change in 16 years, more of which later.
It was a proud fact (not a boast), that in all that time, apart from having to voluntarily refund a patient the cost of an NHS denture that she just couldn’t get right, and a Maryland Bridge that kept falling off, Anna had never had a formal written or verbal complaint in 25 years.
Trouble ‘t mill
And then, in 2013, her life was turned upside down when Dr W came along.
This was around the time that the Care Quality Commission was about to enter UK dentistry and Anna had frankly had enough of administration after single-handedly writing and rewriting all the practice policies over the previous twelve months. Anna had put the practice on the market a few months earlier and she one day got a call from a well-known dental practice seller that a local practitioner was interested in coming to look at the practice.
She vaguely knew of Dr W, having met her very briefly over the years at postgraduate meetings, but couldn’t say she had heard much about her since she worked in a neighbouring county. Anna knew nothing other than Dr W sat on her local Local Dental Committee, and her dentist husband held a prominent position in local academia. The last she had heard, Dr W had been running her own general practice in a town about 20 miles away.
A few days later, Dr W and her husband went to the practice for a viewing. They both seemed affable enough and it transpired that Dr W had sold her practice some time before and then they had both moved to another practice in the same town where they had worked as associates. At the time of the viewing, they had both quit their associate jobs and Dr W was working for a dental corporate some considerable distance away.
Within two days, Anna received a call from the dental estates agent telling her that Dr W had put in an offer at the (modest) asking price for her mixed Denplan/NHS leasehold practice. Within a few days a rudimentary agreement was signed whereby Anna agreed to take the practice off the market and (the miasma of trouble should have become apparent about now) she also signed a confidentiality agreement whereby she wouldn’t reveal the identity of the buyer until near the exchange of contracts. Anna thought this a bit odd, but she knew the climate surrounding practice sales had changed since she had bought the practice in the mid 90’s.
Within a few days of the offer, Dr W requested delaying the progression of the sale while she pursued the lease on another property in the town, which she felt would be more suitable for her plans. Anna agreed to the delay, which she was assured would be a few weeks since the property Dr W sought was already empty and was formerly used as a commercial centre.
Having never sold a practice before, Anna was a little bewildered by the whole sale process (as was her solicitor it turned out) and she thought that Dr W’s request to come in and examine a sample of her patient record cards a few weeks later, was ‘normal’ as part of the ‘due diligence’ process. Turns out, it wasn’t, and even an N95 respirator wouldn’t have protected her from the effluvium of Machiavellian plotting that ensued. At this time, Dr W also casually asked if Anna would drop the price by £30,000. Anna politely declined.
Cutting a long story short, Dr W requested a period of ‘settling in’ before completion, asking to be taken on as an associate before completion. Anna agreed to what she thought at the time was not an unreasonable request, although she wasn’t keen to do this until the exchange of contracts had been completed – at the time she didn’t need an associate and she would have to negotiate with the local NHS Team for more UDA’s.
Say it ain’t so!
As soon as Anna was free of the confidentiality agreement, she was able to speak to colleagues, about her potential buyer. The first person she spoke to was her own, long-standing associate. On hearing the buyer’s name, he apparently turned an ashen-grey – an eerie, unearthly shade even Anna’s dental crown technicians on a bad day would never be able to reproduce. Further chats with colleagues about Dr W revealed that both she and her husband had been dismissed from their previous practice for what was described as ‘inappropriate and unethical behaviour’ – accusations that included stealing the patient database from the practitioner Dr W had sold her practice to and then using it to attract patients to her new practice (which her colleagues were appalled by), bullying staff, and failing to follow cross-infection control guidelines. Remember, she was an LDC member, he was in a postgraduate academic role.
The general advice from everyone Anna spoke to – these included Dr W’s former colleagues AND friends – was ‘Get out of the sale as soon as you can. She is trouble.’ Anna tried, but by the time she had discovered all of this, she had accrued a large legal bill and would have also incurred a huge contract penalty, which she could ill-afford, if she tried to pull out of the deal. (Part of the cause for the six month delay in reaching the contract exchange stage was because of Dr W’s planned move into a new rented property. Eventually, she had to give up on that idea when the landlord of the property called a halt to the negotiations with her after Dr W [in HER own words] “pissed her off.” The landlord (a patient of Anna’s) later said “I would have rather razed the building to the ground than deal with that woman.”)
After another six-month delay due to quibbling over the transfer of the lease to Dr W, completion took place in May 2013. By this time Anna, a women who tolerated everyone, couldn’t stand being in the same town as Dr W, let alone the same building, and she was failing miserably to hide her contempt for the woman from her unfortunate staff.
Money, that’s what I want!
Barely six weeks after completion, Anna received a letter from Dr W’s solicitor, demanding over £30,000 for defective work carried out under her Denplan contract – that’s right – I couldn’t believe the figure either, but it was £30,000 in six weeks. Dr W even provided a list of the patients she had had to do corrective work on, two of whom were personal friends of Anna’s who shared the same initials and unusual surname. Dr W had claimed that she had to replace their partial dentures free of charge – despite the fact that neither had missing teeth, let alone ever worn a prosthesis. Anna could not, of course, since no patient had made a complaint, get access to their records in order to refute the claim.
Anna dismissed her demand out of hand and made it quite clear that the claim was absurd. Not quite sure how she had seen that many patients in six weeks let alone found so many faults, Anna was then advised by former staff that for weeks after the sale, both Dr W and her husband had been taking carrier bags full of patient records home every night – presumably to trawl through and find stuff they could fault Anna on.
It was at this point that in her own mind Anna waved bye-bye to the £8,000 ‘retention fee’ she had been conned into – whereby the buyer kept back a portion of the sale price to pay for defective treatment. It was going nowhere near patients, but to Dr W’s back pocket.
By this time Anna was settling into a new job as an associate in a practice in another county which she was very happy in. Dr W, however, was having (she assumed – for all she knew, she may not have cared) an uncomfortable time, having lost most of Anna’s former staff and an estimated 50% of her Denplan list of patients due to her being frankly, obnoxious.
Yeah, but Roger Whitakker was a whistleblower
Anna dismissed another threat that legal action would be taken if she didn’t settle Dr W’s outrageous demand and then it went quiet for a few weeks until Anna received a call from the NHS Area Team inviting her to an informal interview with colleagues to discuss ‘Anonymous concerns raised by a colleague.”
The two-man panel she met with at the Area Team offices – one public dental health dentist and one senior medic – outlined the anonymous source’s concerns regarding Anna’s patient records. They would not be specific about the charges and refused to name the ‘whistleblower.’ She told the panel exactly who the whistleblower was – Dr W – and precisely why she knew the latter was doing it. Since Dr W was getting nowhere with her civil action to recover the money she felt she was owed, it was Anna’s conclusion that she was by proxy, getting evidence backing up her court claim. By getting professional backup to her claim that Anna was a “wrong ‘un” – it would strengthen Dr W’s claim and make the passage through the county court process much simpler for her.
Anna then spent a tedious 18 months or so, having to read and answer report after report produced by the Area Team’s Dental Practice Advisor and Dr W herself, defending (basically) her record keeping. One accusation was that Anna failed to keep radiographic reporting records, despite the fact that she had introduced separate radiographic record sheets long before the guidelines were introduced and these were audited every three months and reports were produced. The upshot was that she had to read a load of Faculty of Dental Surgery books and go on a treatment planning course – “1) scale and polish 2) cons as charted” not being considered adequate as a treatment plan for a patient who needed a scale and polish and cons as charted. She found the whole process thoroughly humiliating.
So when the Area Team indicated to Dr W that its conclusion was not going to be detrimental to the continuation of Anna’s career, she tried another tack.
Then the ‘heavies’ moved in
Yes, you guessed it, the General Dental Council reared its ugly head. Dr W had managed to persuade three patients to complain regarding treatment. Two complaints regarded crowns (one each patient). One Denplan lady had to see a specialist for endo within a year of Anna providing a crown. She was still having the endo done when Anna left the practice. Anna had previously promised the patient she would replace the crown free of charge, but left in the meantime. She did refund the lab fee the patient was charged at the time – to Anna’s recall she refunded more than the cost of the gold crown the patient requested. The patient was claiming about £650 – the charge Dr W was going to demand from her for its replacement. Another patient also needed a crown replaced after it became non-vital and she wanted a similar amount having been quoted some outlandish cost by Dr W for another crown. At least one of these patients had been told by Dr W that “I would get more money if I went to the General Dental Council.” Of course, they got “nowt.”
In both of the above cases Anna got a slap on the wrist from the Preliminary Professional Conduct Committee (the ‘paperwork’ committee that decides if a dentist should go to a hearing) for her paperwork. What Anna learned, very hard, is that when a complaint goes to the GDC, they not only look at the complaint, they look at EVERYTHING a dentist has EVER done to that patient and if treatment isn’t in contention, it will be considered. On one patient, a colleague had seen Anna’s patient for pain, had taken an x-ray and had noted a radiolucency on the base of a lower five. He then booked the patient in for RCT with Anna. It was obvious to even a trainee dental nurse with a fortnight’s experience that the patient needed an RCT, but she was criticised for proceeding with RCT without justifying why RCT was necessary, and not noting that she had discussed extraction with the patient (who had just spent £850 on saving a lower second molar with the endodontist).
In the first response to the third female patient who complained, she was advised that she wouldn’t be getting any money and that the GDC was only interested in disciplinary matters. The patient then lost interest and went to a dental litigation lawyer instead. The GDC kept their interest however, and again, tried to rip Anna apart. That civil litigation has only just concluded, which is why Anna now feels free to now speak about her ordeal.
Good Morning Judge
Timing is everything, and once Dr W realised she was getting nowhere with securing a GDC sanction against Anna, she went to court. In January 2017, Anna found herself facing the prospect of a two day hearing in the county court and the possibility that if the court found even £1 of Dr W’s claim was valid, she would be forced to pay Dr W his total claim (the original £30,000 plus his legal fees) as well as the county court hearing costs. Anna estimated it would wipe her out financially. After cashing in a pension, she paid Dr W just over £40,000 as well as losing the £8,000 retention fund, which she knew full well never went anywhere near a patient.
Take Notes. I’ll be asking questions later.
Now, Anna didn’t allow me to tell this as a tale of woe to garner any sympathy for her.
It is written as a warning to colleagues to be exceptionally scrupulous with regard to their note-taking, treatment planning and interactions with not only patients but especially their colleagues. The practitioner to whom Anna refers had also embezzled money directly from the owner’s of the practice she was dismissed from, but she was so unpleasant and litigious, they preferred not to take it any further, having managed to finally rid themselves of her.
The whole episode stretched from June 2013 until December 2017 and in that time Anna had not only lost a considerable amount of money, she lost four years of her spare time as well as spilling a lot of her stress on to her husband and family.
As a consequence of her experiences, Anna now write her notes like “I am writing War and Peace and I frankly, practice defensively, assuming every patient is a potential adversary.” She admits it’s not a pleasant way to practice in a profession she used to love and was obsessed with, but at least it may keep her away from the London Underground and tedious trips to meet up with the lawyers and the “Superb dental advisor from my indemnity organisation.” A positive outcome Anna gleaned from the whole affair was that “I was reassured to see first hand, that in my case at least, the GDC process was overall fair and measured.”
I’m not going to lay out exactly the lessons Anna learned because they should be pretty obvious. Although she herself admitted: “I am not the best dentist in the world, I was, I thought, I good sound practitioner and it would never happen to me.”
What happened to Dr W?
Even though dentists might be in Anna’s position and knows exactly who is responsible for putting patients up for complaining to the GDC, practitioners cannot attack the practitioner responsible in their defence. That was a lesson Anna learned hard.
Having been furnished with irrefutable evidence of Dr W’s dishonesty with regard to NHS patient charges and claims, Dr W was reported (by Anna) to the NHS Fraud Department. The Fraud investigators found there was a case to answer and so they referred her on to the GDC. After a year-long investigation, Dr W somehow escaped sanction from the GDC. Anna reveals she still has stuff on file she will consider submitting to the authorities should she hear from Dr W ever again.
By Ollie Jupes 