hearing heard in public hodge, michael george registration

HODGE, M G Professional Conduct Committee – Aug 2021 Page -1/21-

HEARING HEARD IN PUBLIC

HODGE, Michael George

Registration No: 41861

PROFESSIONAL CONDUCT COMMITTEE

AUGUST 2021

Outcome: Suspension for 6 months with immediate suspension (with a review)

HODGE, Michael George, a dentist, BDS Lond 1967, FDS Royal College of Surgeons of England 1971, MB BS Lond 1976, M Royal College of Surgeons Of England 1976, L Royal College of Physicians of London 1976, was summoned to appear before the Professional Conduct Committee on 23 August 2021 for an inquiry into the following charge:

Charge

“That being a registered dentist:

1. You failed to provide an adequate standard of care to Patient A in that:

a) Prior to commencing treatment on 22 February 2012 you did not:

i. conduct a review of Patient A’s medical history;

ii. undertake a clinical assessment of Patient A’s LL6 to ascertain the complexity of extraction;

iii. undertake any, or any adequate, assessment of available intra-oral radiographs showing Patient A’s LL6;

b) On 22 February 2012:

i. You caused damage to Patient A’s Left Inferior Alveolar Nerve (IAN) during surgery to extract Patient A’s LL6;

ii. You failed to diagnose damage to Patient A’s Left IAN;

c) Between 23 February and 4 July 2012:

i. You failed to ensure that protocols were in place to ensure you were informed of complications in respect of Patient A;

ii. You failed to ensure that appropriate radiological assessment was undertaken in the immediate post-operative period;

d) You failed to arrange and/or undertake a review of Patient A prior to 30 May 2012;

e) On 30 May 2012:

i. You failed to take a radiograph to assess the patency of Patient A’s Inferior Dental Canal (IAC);

ii. You failed to undertake any two-point assessment;

iii. You failed to undertake any assessment of proprioception;


iv. You failed to undertake any assessment of detection of movement of object of Patient A’s skin;

f) On 4 July 2012:

i. You failed to report on a periapical radiograph taken on 4 July 2012;

ii. You failed to undertake any two-point assessment;

iii. You failed to undertake any assessment of proprioception;

iv. You failed to undertake any assessment of detection of movement of object of Patient A’s skin;

g) You failed to arrange further imaging, such as a cone-beam computed tomography (CBCT) scan following a panoramic radiograph taken between 4 and 13 July 2012;

h) You failed to arrange a specialist referral for Patient A or you failed to undertake the required specialist management of Patient A,

2. You failed to maintain an adequate standard of record keeping in respect of Patient A in that:

a) On 22 February 2012 you did not record:

i. any clinical notes relating to examination and assessment of Patient A’s LL6;

ii. any review of Patient A’s medical history;

iii. any clinical assessment of Patient A’s LL6 including the complexity of any extraction;

iv. any radiographic assessment or report including in regards to root morphology or position of Patient A’s LL6 in relation to the IDC;

v. whether or not tranexamic acid was provided to Patient A and, if not, the justification for your decision;

b) On 30 May 2012 you did not record:

i. A description of the nature or character of the numbness experience by Patient A;

ii. Patient A’s assessment morbidity in respect of the injury to Patient A’s IAN;

iii. A history of the injury to Patient A’s IAN;

iv. A map, photograph or diagram of the affected area of Patient A’s skin;

v. A record of any two-point assessment;

vi. Assessment of proprioception;

vii. Assessment of detection of movement of object of Patient A’s skin;

viii. A map or description of intra-oral distribution of change in feeling;

c) On 4 July 2012 you did not record:

i. A record of any examination;


ii. A description of the nature or character of the numbness experience by Patient A;

iii. Patient A’s assessment morbidity in respect of the injury to Patient A’s IAN;

iv. A history of the injury to Patient A’s IAN;

v. A map, photograph or diagram of the affected area of Patient A’s skin;

vi. A record of any two-point assessment;

vii. Assessment of proprioception;

viii. Assessment of detection of movement of object of Patient A’s skin;

ix. A map or description of intra-oral distribution of change in feeling;

3. You failed to adequately respond to Patient A’s letter of complaint dated 7 December 2018.

4. You informed Patient A that the cause of injury to her IAN was:

a) local anaesthetic injections for treatment to Patient A’s UL8.;

b) local anaesthetic injections for treatment to Patient A’s LL6;

5. Your conduct in respect of Charge 4(a) was:

a) Misleading;

b) Dishonest, in that local anaesthetic injections for Patient A’s UL8 could not result in injury to Patient A’s left IAN.

6. Your conduct in respect of Charge 4(b) was:

a) Misleading;

b) Dishonest, in that such a statement was not supported by the assessments of the injury that had been undertaken.

AND that by reason of the matters alleged, your fitness to practice is impaired by reason of your misconduct.”

As Mr Hodge did not attend and was not represented at the hearing, the Chairman made a statement regarding proof of service on 23 August 2021.

Decision on service of the Notification of Hearing

“The Committee first considered whether notice of the hearing had been served on Mr Hodge in accordance with Rules 13 and 65. It received a bundle of documents containing a copy of the Notification of Hearing letter, dated 13 July 2021. Also contained within the bundle was a Royal Mail ‘Track and Trace’ receipt confirming that the letter was sent to Mr Hodge’s registered address by Special Delivery. The Committee took into account that there is no requirement within the Rules for the GDC to prove receipt of the letter. However, it noted from the ‘Track and Trace’ information that the letter was delivered and signed for at Mr Hodge’s registered address on 14 July 2021. A copy of the letter was also sent to him by email.


The Committee was satisfied that the Notification of Hearing letter of 13 July 2021 contained proper notification of the hearing, including its start date, time and venue, as well as notification that the Committee could proceed with the hearing in Mr Hodge’s absence. On the basis of the information provided to it, the Committee was satisfied that notice of the hearing had been served on Mr Hodge in accordance with the Rules. Mr Hodge has responded to the GDC via email on 9 and 12 August 2021.

Decision on whether to proceed with the hearing in the absence of Mr Hodge

The Committee next considered whether to exercise its discretion under Rule 54 of the Rules to proceed with the hearing in the absence of Mr Hodge and/or any representative on his behalf. It approached the issue with the utmost care and caution, noting his right to attend and participate. The Committee had regard to the factors to be considered in reaching its decision as set out in the case of R v Jones [2003] 1 AC 1HL, and the public interest considerations referred to in Adeogba v GMC [2016] EWCA CIV 162 as well as the obligation on professionals to engage with their regulator. It took into account that fairness to Mr Hodge was of primary importance, but also remained mindful of the need to be fair to the GDC. The Committee also took into account the public interest in dealing with Mr Hodge’s case expeditiously.

The Committee noted that the last contact from Mr Hodge was an email dated 12 August 2021 He responded by stating “Thank you for your assistance. I will not be taking part in the hearing as my health is deteriorating. I wish to apply for voluntary erasure. I accept that in this case my fitness to practice was impaired. This is my only time in over 45 years that a patient has reported me to the GDC I have not been in clinical practice for over 5 years and have no intention of practising again…”

The Committee was satisfied from the information before it, that Mr Hodge had been aware of the hearing and has had formal notice of the hearing from at least 14 July 2021. Considering all the information before it and Mr Hodge’s recent responses, it was satisfied that Mr Hodge had voluntarily decided not to attend the hearing. The Committee considered that Mr Hodge had had several opportunities to ask the GDC for an adjournment, but there was no indication that he made such a request. In the circumstances, the Committee concluded that it was unlikely that an adjournment of the hearing would secure Mr Hodge’s attendance on a future occasion.

The Committee was satisfied that in effect that Mr Hodge had chosen to disengage with the process. A number of letters sent by the GDC to the Registrant informed him of the procedures involved with making a voluntary removal application, and that this will only proceed if he submits further documentation. To date no further documentation has been received and there is no current application from Mr Hodge. The Committee notes that the GDC has not received any medical evidence with regards to his current state of health. The Committee is satisfied that Mr Hodge is aware that these proceedings today are not in relation to a voluntary removal application.

The Committee was mindful that all professionals have an obligation to engage with their regulator, and that it would run entirely counter to the protection, promotion and maintenance of the health and safety of the public if a practitioner could effectively frustrate the regulatory process. Bearing in mind the number and complexity of the allegations and the public interest in the expeditious conduct of the GDC’s regulatory function, the Committee had no hesitation concluding that it was fair and in the interests of justice for the hearing to proceed in the absence of Mr Hodge.”


On 23 August 2021 the Chairman a statement regarding the preliminary application.

“Decision on the preliminary application made by the GDC to amend the charge under Rule 18

Ms Price provided an amendment under Rule 18 to amend the date within Head of Charge 3 so it reads “1 December 2018” and not “7 December 2018” as it is currently drafted due to a typographical error.

Ms Price’s submission was that this amendment is not unfair nor does it lead to any injustice or prejudice to the Registrant. Mr Hodge has been notified in advance of this hearing of this proposed amendment.

The Committee accepted the advice of the Legal Adviser. In granting the application, it had regard to the merits of the case and the fairness of the proceedings, and it was content that the proposed amendment could be made without causing injustice to Mr Hodge. The Committee was satisfied that the suggested amendment was to correct a typographical error It accepted that the amendment does not change the substance of the charge against Mr Hodge.

The charge was amended accordingly.”

On 25 August 2021 the Chairman announced the findings of fact to the Counsel for the GDC:

“Ms Price

Background

The GDC investigation of Mr Hodge’s case relates to his alleged treatment of Patient A over a period between 22 February 2012 and 4 July 2012 spanning 3 appointments. Patient A was referred to Mr Hodge internally and attended the practice on 22 February 2012 for the extraction of her lower left first molar and a wisdom tooth. During this appointment her molar tooth (LL6) was cut in two parts and extracted. After the treatment she felt numbness in her lip which persisted the next day and so she contacted the practice and was offered an appointment for 24 February 2012 with her regular dentist TH, who advised her that the numbness may continue for some time.

Patient A states that she was also seen by the Registrant on 30 May 2012 and 4 July 2012. She alleges that Mr Hodge advised her that the numbness was probably due to the local anaesthetic injection. Patient A sent a letter of complaint to Mr Hodge on 1 December 2018. Patient A still experiences numbness in her lip. After assessment with a consultant and maxillofacial surgeon on 17 August 2017, this was described as “she still has gross touch, proprioception and two-point discrimination test however the latter is mildly compromised.”

A complaint dated 1 December 2018 was made to the practice. The matter was subsequently referred to the GDC. During the GDC’s investigation an expert report was obtained where a number of criticisms were made which now form the basis of the heads of charge before this Committee.

Evidence

The Committee received a written statement dated 21 March 2021 from Patient A with supporting exhibits. It also received an expert report dated 2 April 2021 on behalf of the GDC from Professor Brook.


The Committee heard oral evidence from the 2 GDC witnesses: Patient A and Professor Brook.

The Committee also received copies of Patient A’s records from the practice and a subsequent treating hospital.

Mr Hodge was not present during this hearing and there was no substantive response or independent evidence from Mr Hodge. However, the GDC had received emails from Mr Hodge, in one of which he accepted that his fitness to practise was impaired in the case of Patient A.

The Committee when considering all the charges, was directed to relevant cases including Re H [1996] 1 All ER 1996 and with regards to dishonesty the case of Ivey v Genting Casinos (UK) limited [2017] UKSC 67. The Committee took these into account when deliberating.

The Committee has taken into account all the evidence presented to it. It has accepted the advice of the Legal Adviser. In accordance with that advice it has considered each head of charge separately.

I will now announce the Committee’s findings in relation to each head of charge:

1. You failed to provide an adequate standard of care to Patient A in that:

1.a. Prior to commencing treatment on 22 February 2012 you did not:

1. a) i) conduct a review of Patient A’s medical history;

Proved.

The Committee notes the main sources of evidence in this case are Patient A’s clinical records and Professor Brook’s expert report. In respect of this head of charge, the notes show that that Mr Hodge had not made a record of conducting a review of Patient A’s medical history. The Committee notes that medical histories were taken and recorded previously by Mr Hodge’s colleagues, most recently during an appointment on 10 February 2012.

Patient A stated in her written evidence that there was no discussion of her medical history during the appointment of 22 February 2012. This was supported by the evidence of Professor Brook in his report and the clinical notes which were available to the Committee.

The Committee having taken into account all the evidence, considers that on the balance of probabilities, it was more likely than not that Mr Hodge had failed to conduct a review of Patient A’s medical history.

It therefore finds this head of charge proved.

1. a) ii) undertake a clinical assessment of Patient A’s LL6 to ascertain the complexity of extraction;

Not proved.

The Committee took into account the clinical notes entered by Mr Hodge and the report of Professor Brook.

The Committee is satisfied that there is a note recording that this was a complex surgical extraction. It is not entirely clear whether this assessment was made


prior to or after the treatment.

The Committee considers that the GDC has not provided sufficient evidence to prove this head of charge to the required standard.

It therefore finds this head of charge not proved.

1. a) iii) undertake any, or any adequate, assessment of available intra-oral radiographs showing Patient A’s LL6;

Not proved.

The Committee notes that no record of such an assessment was made. However, it notes that radiographs were previously taken on 10 February 2012, 12 days prior to the appointment. Mr Hodge stated it was a complex surgical extraction.

Patient A stated in written evidence that when she was told by Mr Hodge that the extraction was difficult, and he told her that he could not see the tooth properly on the x-ray.

The Committee is satisfied that an assessment was made. The Committee reflected on whether this assessment was adequate.

The Committee notes that Mr Hodge assessed the extraction as complex and made detailed descriptions of some of the issues which would not have been possible without looking at the radiographs. It considers that it would be improbable that a dentist of over 45 years’ experience would not have assessed the radiographs available in preparation for treatment.

The Committee therefore concludes on the balance of probabilities that Mr Hodge had undertaken an adequate assessment of available intra-oral radiographs showing Patient A’s LL6.


1.b. On 22 February 2012:

1. b) i) You caused damage to Patient A’s Left Inferior Alveolar Nerve (IAN) during surgery to extract Patient A’s LL6;

Proved.

The Committee interprets the word surgery to mean the surgical procedure only, not including the administering of a local anaesthetic.

The Committee accepts the opinion of Professor Brook. In his report he stated “The image of the IDC in the LL6 area is slightly obscured by superimposition of the body of the hyoid bone, but a discontinuity/narrowing of the IDC (arrow) can be seen (reduced patency).There is continuity (no bone) between the base of the distal root socket and the IDC.”

Professor Brook stated that the injury on the balance of probabilities was more likely to have been caused by the surgery provided by Mr Hodge than by the anaesthetic. However, in response to Committee questions, he stated that as he had not examined the patient himself, he could not be certain that it was the surgery and not the local anaesthetic that had caused damage.


The Committee is satisfied that there was some damage caused during the procedure, and Patient A’s evidence supports this.

The Committee is satisfied that it is more likely than not that the damage was caused by surgery rather than during the administration of the local anaesthesia and therefore finds this head of charge proved.

1. b) ii) You failed to diagnose damage to Patient A’s Left IAN;

Not proved.

The Committee bore in mind that “failed” means a culpable failure requiring the GDC to prove there was a duty to do something which was not carried out.

The Committee notes that the patient was numb on leaving the appointment, having been administered a local anaesthetic. The Committee considers that it would not be expected that Mr Hodge would diagnose any damage at that stage because Patient A was still experiencing the after effects of a local anaesthetic.

The Committee is satisfied that any issues would not have come to light until the anaesthetic had worn off, by which time Patient A had left the appointment.

The Committee finds this head of charge not proved.

1.c. Between 23 February and 4 July 2012:

1. c) i) You failed to ensure that protocols were in place to ensure you were informed of complications in respect of Patient A;

Not proved.

The Committee notes that a post-operative sheet was given to Patient A which included an address and a contact number as well as advice about how to seek assistance from Mr Hodge at the Hospital, and that Mr Hodge regularly attended Patient A’s practice which allowed scope for follow up enquiries.

The Committee notes that Patient A rang the practice and was given an appointment for 24 February 2012 to report a complication, as directed by the post-operative advice sheet. This shows she was aware of how to access further care.

The Committee is satisfied that there were some communication channels in place to ensure that Mr Hodge was informed of any complications in respect of Patient A.

The Committee finds this head of charge not proved.

1. c) ii) You failed to ensure that appropriate radiological assessment was undertaken in the immediate post-operative period;

Not proved.

The clinical notes suggest that Mr Hodge did not see Patient A between the dates specified in this head of charge.

The Committee notes a letter from Mr Hodge dated 14 July 2012, reporting the findings of a OPG radiograph. This radiograph was arranged by another


colleague after Patient A attended on 4 July 2012.

Patient A maintains that she saw Mr Hodge on 4 July 2012, however, her account in oral evidence is that she saw Mr Hodge “a total of 1 or 2 times”; furthermore clinical notes attribute the 4 July 2012 appointment to another practitioner.

The Committee does not accept the evidence of Patient A, and in particular her recollection of an appointment. It accepts the records made in Patient A’s notes indicating she was seen by TH and is satisfied that Mr Hodge was not culpable in failing to organise a radiological assessment.

The Committee is satisfied on the balance of probabilities that there was not a failure on Mr Hodge’s part and finds this head of charge not proved.

1. d) You failed to arrange and/or undertake a review of Patient A prior to 30 May 2012;

Not proved.

The Committee noted that the initial appointment was on 22 February 2012 and Patient A then contacted the practice for a follow-up appointment. Clinical notes record that this took place on 24 February 2012 and the appointment was with TH and not Mr Hodge. Patient A was advised to return in a month’s time. There was no evidence to confirm that Patient A had attended that appointment.

The Committee is satisfied that as Patient A apparently declined the proposed follow-up appointment, Mr Hodge did not fail to arrange a review of Patient A prior to 30 May 2012.


1.e On 30 May 2012:

1. e) i) You failed to take a radiograph to assess the patency of Patient A’s Inferior Dental Canal (IAC);

Not proved.

Patient A’s written evidence was that she saw Mr Hodge on 30 May 2012. However, in her oral evidence, Patient A was not sure about this and thought that the appointment would have been with her normal dentist TH.

In Patient A’s oral evidence, she stated that she had seen Mr Hodge for total of 1 or 2 occasions. The Committee considers that her evidence is slightly unclear about when she saw Mr Hodge and contradicts the records which indicate only 1 appointment with him.

The clinical notes record the appointment being with a dentist with the initials “CN” and which also state “review when mike is back for x-ray” The Committee is satisfied that this is conclusive evidence that Mr Hodge was not at that appointment.

The Committee therefore finds this head of charge not proved.

1. e) ii) You failed to undertake any two-point assessment;


Not proved.

For the reasons given in head of charge 1.e) i).

1. e) iii) You failed to undertake any assessment of proprioception;

Not proved.


1. e) iv) You failed to undertake any assessment of detection of movement of object of Patient A’s skin;

Not proved.


1.f. On 4 July 2012:

1. f) i) You failed to report on a periapical radiograph taken on 4 July 2012;

Not proved.

In the clinical notes it appears that on 4 July 2012 Patient A saw TH, her regular treating dentist. Patient A has stated in oral evidence that she remembers the appointment being with Mr Hodge.

The Committee is satisfied that Patient A did not see Mr Hodge on 4 July 2012.

The Committee is satisfied that Mr Hodge was not at that appointment so he was not able to report on that radiograph.

The Committee therefore finds this head of charge not proved.

1. f) ii) You failed to undertake any two-point assessment;

Not proved.

For the same reasons as given in head of charge 1.f) i).

1. f) iii) You failed to undertake any assessment of proprioception;

Not proved.


1. f) iv) You failed to undertake any assessment of detection of movement of object of Patient A’s skin;

Not proved.


1. g) You failed to arrange further imaging, such as a cone-beam computed tomography (CBCT) scan following a panoramic radiograph taken between 4 and 13 July 2012;

Not proved.

The clinical notes record that on 4 July 2012 a panoramic radiograph was taken. Those notes are in the context of an appointment with TH.

The Committee notes Professor Brook’s opinion that further explorative and


radiologic assessment should have been taken. The Committee noted Mr Hodge’s letter dated 13 July 2012 where he states he has seen the radiograph taken by Accessible Orthodontics. The Committee was satisfied that Mr Hodge was in a position to arrange further imaging as he had seen the OPG radiograph.

However, the Committee having assessed all of the evidence before it, considers that it has not been provided with evidence of what advanced imaging was available to Mr Hodge at the time of the referral. The Committee is satisfied that the GDC needed to demonstrate evidence that such advanced imaging was available for referral at that time.


1. h) You failed to arrange a specialist referral for Patient A or you failed to undertake the required specialist management of Patient A,

Proved.

The Committee notes Professor Brook’s evidence that Mr Hodge should have either arranged specialist imaging or arranged a specialist referral.

The Committee noted Mr Hodge’s letter dated 13 July 2012 where he confirms that he has seen the radiograph taken by Accessible Orthodontics.

The Committee accepts the evidence of Professor Brook that Mr Hodge had a duty to arrange a specialist referral or undertake the required specialist management of Patient A when he had seen the radiograph.

The Committee finds that as this was not carried out, this head of charge is proved.

2. You failed to maintain an adequate standard of record keeping in respect of Patient A in that:

2.a. On 22 February 2012 you did not record:

The Committee considers that the majority of the clinical notes may not be adequate and are incomplete.

2. a) i) any clinical notes relating to examination and assessment of Patient A’s LL6;

Proved.

The Committee notes that there is a brief mention of the complexity of the extraction but the records do not give details of any examination or assessment.

The Committee is satisfied that this head of charge is proved.

2. a) ii) any review of Patient A’s medical history;

Proved.

The Committee found no record of any review of Patient A’s medical history in the clinical notes.


2. a) iii) any clinical assessment of Patient A’s LL6 including the complexity of any


extraction;

Not proved.

The Committee notes that in the clinical notes there is a brief mention of a complex extraction. Although the Committee considers that the notes could have been more detailed, it considers that this brief record relates to the complexity of any extraction and finds this head of charge not proved.

2. a) iv) any radiographic assessment or report including in regard to root morphology or position of Patient A’s LL6 in relation to the IDC;

Proved.

The Committee found no record of any radiographic assessment or report including in regard to root morphology or position of Patient A’s LL6 in relation to the IDC in the clinical notes.


2. a) v) whether or not tranexamic acid was provided to Patient A and, if not, the justification for your decision;

Proved.

There is no record of this in the clinical notes.


2.b. On 30 May 2012 you did not record:

2. b) i) A description of the nature or character of the numbness experienced by Patient A;

Not proved.

The Committee having found that Mr Hodge did not conduct this appointment, finds that he could not be culpable as he was not at that appointment, therefore, he did not have a duty to maintain a record of any aspect of the appointment.


2. b) ii) Patient A’s assessment morbidity in respect of the injury to Patient A’s IAN;

Not proved.

For the reasons provided in head of charge 2. b) i).

2. b) iii) A history of the injury to Patient A’s IAN;

Not proved.


2. b) iv) A map, photograph or diagram of the affected area of Patient A’s skin;

Not proved.


2. b) v) A record of any two-point assessment;


Not proved.


2. b) vi) Assessment of proprioception;

Not proved.


2. b) vii)

Assessment of detection of movement of object of Patient A’s skin;

Not proved.


2. b) viii)

A map or description of intra-oral distribution of change in feeling;

Not proved.


2.c). On 4 July 2012 you did not record:

Not proved.


2. c) i) A record of any examination;

Not proved.

The Committee having found that Mr Hodge did not conduct this appointment, finds that he could not be culpable as he was not at that appointment, therefore, he did not have a duty to maintain a record of any aspect of the appointment.

2. c) ii) A description of the nature or character of the numbness experience by Patient A;

Not proved.


2. c) iii) Patient A’s assessment morbidity in respect of the injury to Patient A’s IAN;

Not proved.


2. c) iv) A history of the injury to Patient A’s IAN;

Not proved.


2. c) v) A map, photograph or diagram of the affected area of Patient A’s skin;

Not proved.


2. c) vi) A record of any two-point assessment;

Not proved.



2. c) vii) Assessment of proprioception;

Not proved.


2. c) viii)

Assessment of detection of movement of object of Patient A’s skin;

Not proved.


2. c) ix) A map or description of intra-oral distribution of change in feeling;

Not proved.


3. You failed to adequately respond to Patient A’s letter of complaint dated 1 December 2018.

Proved.

The Committee took account of the letter from Patient A dated 1 December 2018 where she gives details about her concerns regarding the treatment that Mr Hodge provided.

The Committee notes that Patient A received only one response back from Mr Hodge, dated 31 December 2018, which states “Your letter and attachments were safely received. I have been unwell and will reply later this week. Apologies for the delay. Kind Regards”

The Committee is satisfied that this is mainly a holding response to confirm that he would come back to Patient A at a later date. However, Mr Hodge failed to do so.

The Committee is satisfied that Mr Hodge failed to adequately respond to Patient A’s letter of complaint dated 1 December 2018.


4. You informed Patient A that the cause of injury to her IAN was:

4. a) local anaesthetic injections for treatment to Patient A’s UL8.;

Not proved.

The Committee took into account the witness statement of Patient A and in particular paragraph 13 where she states “Mr Hodge told me that the numbness was probably due to the injection of the local anaesthetic and not the extraction.”

The Committee also took into account the letter sent by Mr Hodge dated 13 July 2012 to Patient A, where he states “It now looks unlikely that the extraction was the cause of your numbness. It is much more likely to be due to the injection of local anaesthetic.”

The Committee having considered all the evidence before it, considers that Mr Hodge’s letter does not specifically relate to Patient A’s UL8.


The Committee is satisfied that Mr Hodge did inform Patient A that the cause of loss of sensation was the local anaesthetic injection. However, the Committee considers it more likely than not that Mr Hodge was discussing specifically Patient A’s LL6 rather than her UL8.

Patient A’s recollection was unclear at times, and accordingly the Committee finds this head of charge not proved.

4. b) local anaesthetic injections for treatment to Patient A’s LL6;

Proved.

The Committee took into account the letter sent by Mr Hodge dated 13 July 2012 to Patient A, where he states “It now looks unlikely that the extraction was the cause of your numbness. It is much more likely to be due to the injection of local anaesthetic.”

The Committee having considered that Mr Hodge’s letter of 13 July 2012 was probably describing the issue of Patient A’s LL6, the Committee is satisfied that this head of charge is found proved.

5. Your conduct in respect of Charge 4(a) was:

5. a) Misleading;

Not proved.

Having found head of charge 4(a) not proved, this head of charge falls away.

5. b) Dishonest, in that local anaesthetic injections for Patient A’s UL8 could not result in injury to Patient A’s left IAN.

Not proved.

Having found head of charge 4(a) not proved, this head of charge falls away.

6. Your conduct in respect of Charge 4(b) was:

6. a) Misleading;

Proved.

The Committee understands the meaning of the word misleading to be causing someone to believe something is true when it is not, regardless of intent.

The Committee noted Professor Brook’s opinion that Mr Hodge’s letter could be considered as misleading because in Professor Brook’s experience, the cause of the injury was more likely to have been the surgery that Mr Hodge had performed on 22 February 2012.

Patient A was informed by Mr Hodge that the cause of her injury was most likely to have been the local anaesthetic injection.

The Committee when considering whether his actions were misleading, took into account the content of his letter of 13 July 2012, and is satisfied that Mr Hodge’s conduct in this respect misled Patient A.



6. b) Dishonest, in that such a statement was not supported by the assessments of the injury that had been undertaken.

Not proved.

In considering the issue of dishonesty, the Committee considered the content of the GDC bundle and whether the evidence offered other possible explanations for Mr Hodge’s actions, and if so whether it could safely conclude that those other explanations were less probable than dishonesty.

The Committee applied the test of dishonesty as set out in Ivey v Genting Casinos (UK) limited [2017] UKSC 67. Accordingly, it first sought to ascertain Mr Hodge’s actual state of knowledge or belief.

The Committee considers that Mr Hodge, a dentist of over 45 years’ experience could reasonably believe that the cause of Patient A’s injury was the local anaesthetic injection.

The Committee considers that Mr Hodge may have genuinely believed the anaesthetic to be the cause, and Professor Brook could not be certain that this was not the case.

The Committee is satisfied that the lack of cogent evidence, together with Mr Hodge’s good character, make it improbable that he would deliberately mislead Patient A.

The Committee is satisfied that an ordinary decent member of the public would not consider that Mr Hodge was dishonest. The Committee notes that the burden of proof is on the GDC to prove that he was dishonest, and the Committee is satisfied that the GDC has not provided sufficiently cogent evidence to find this head of charge proved to the required standard.


We move to stage 2.”

On 26 August 2021 the Chairman announced the determination as follows:

“Having announced its decision on the facts, in accordance with Rule 20 of the Fitness to Practise Rules 2006, the Committee heard submissions from Ms Price, on behalf of the GDC in relation to the matters of misconduct, impairment and sanction. The Committee also received advice from the Legal Adviser which it accepted. The Committee reminded itself that its decisions on misconduct, impairment and sanction are matters for its own independent judgement. There is no burden or standard of proof at this stage of the proceedings. It also had regard to its duty to protect the public, declare and uphold proper standards of conduct and competence and maintain public confidence in the profession. Where applicable, the Committee took into consideration the GDC’s “Standards for Dental Professionals” (May 2005) and the Guidance for the Practice Committees, including Indicative Sanctions Guidance, (October 2016, revised December 2020) (“the Practice Committee Guidance”). The Committee also had regard to relevant case law.


Submissions

In accordance with Rule 20 (1) (a) Ms Price informed the Committee that Mr Hodge has no fitness to practise history.

With regard to misconduct, Ms Price referred the Committee to the cases of Roylance v General Medical Council (No 2) [2000] 1 AC 311 and R (Remedy UK Ltd) v GMC [2010] EWHC 1245 (admin). Ms Price cited Professor Brook’s expert report, which concluded that Mr Hodge’s actions in respect of the clinical matters fell, “far below the expected standards”. She submitted that this was a complex extraction and Mr Hodge failed to conduct a review of the medical history of Patient A which could affect the treatment he would provide. Ms Price submitted that this was a preventable injury. This was compounded by the fact that he was aware of the damage caused during the appointment on 22 February 2021, and subsequently failed to refer to a specialist, which could have prevented the damage becoming permanent. Mr Hodge had informed Patient A that the cause of injury to her IAN was local anaesthetic injections for treatment to Patient A’s LL6 . Ms Price submitted that Mr Hodge’s conduct in this respect was found to be misleading. Patient A has stated in her written statement that she still experiences numbness in her lip to this very day and feels let down and misled by Mr Hodge. Ms Price submitted that the damage caused had created a detrimental effect on Patient A.

Ms Price submitted that there were also failings with regards to Mr Hodge’s record keeping and a failure to deal adequately with Patient A’s complaint.

Ms Price outlined the specific GDC standards, which in her submission have been breached. She submitted, therefore, that all the facts found proved by the Committee clearly amount to multiple breaches of the GDC’s Standards, are serious and constitute misconduct.

Ms Price then moved on to the issue of current impairment. She referred the Committee to the case of Cohen v GMC [2008] EWCH 581 (Admin) and Dame Janet Smith’s Fifth Shipman Report. She submitted that Mr Hodge’s conduct had put patients at risk of harm and, in addition to his failure to comply with the GDC’s investigation, had brought the profession into disrepute. She further submitted that Mr Hodge has provided no evidence that he has attempted to remediate the concerns. She also stated that he has made no specific admissions to the allegations, has shown no regret and no insight into his actions. She addressed the Committee on the need to have regard to protecting the public and the wider public interest. This included the need to declare and maintain proper standards and to maintain public confidence in the profession and in the GDC as its regulator. She concluded that the public would be at significant risk of harm and public confidence in the profession would be undermined if a finding of impairment was not made in this case.

Ms Price next addressed the Committee on the matter of sanction. She made reference to the Practice Committee Guidance and submitted that the appropriate and proportionate sanction would be one of suspension for a period of 6 months with a review hearing before the end of the period.

Misconduct

The Committee first considered whether the facts found proved against Mr Hodge amounted to misconduct. In doing so it had regard to the GDC publication at that time, ‘Standards for Dental Professionals’ May 2005.

It determined that Mr Hodge had breached the following sections in particular:


1.1 Put patients’ interests before your own or those of any colleague, organisation or business.

1.2 Follow these principles when handling questions and complaints from patients and in all other aspects of nonclinical professional service.

1.3 Work within your knowledge, professional competence and physical abilities. Refer patients for a second opinion and for further advice when it is necessary, or if the patient asks. Refer patients for further treatment when it is necessary to do so.

1.4 Make and keep accurate and complete patient records, including a medical history, at the time you treat them. Make sure that patients have easy access to their records.

1.5 Give patients who make a complaint about the care or treatment they have received a helpful response at the appropriate time. Respect the patient’s right to complain. Make sure that there is an effective complaints procedure where you work and follow it at all times. Co-operate with any formal inquiry into the treatment of a patient.

1.10 Do not make any claims which could mislead patients.

5.3 Find out about current best practice in the fields in which you work. Provide a good standard of care based on available up-to-date evidence and reliable guidance.

6.0 Be trustworthy.

In addition to the Standards, the Committee also took into account Professor Brook’s expert report.

The Committee noted that Mr Hodge’s clinical failings relate to a single clinical appointment regarding one patient. The clinical notes suggest that TH her own dentist had advised Patient A to come back in a month’s time, but the next recorded attendance was some three months later. However, the Committee notes that this was a preventable injury which resulted in long term harm to Patient A. Mr Hodge could have referred Patient A for specialist treatment but failed to do so. The Committee has found proved that Mr Hodge had misled Patient A by informing her that her injury was caused as a result of the local anaesthetic injection. Patient A is experiencing numbness in her lip to this day. The Committee is satisfied that this is clear negligent conduct. The Committee considers that the harm his misleading conduct has caused, means that public confidence in the profession would be severely undermined.

The Committee noted Professor Brook’s conclusions in his expert report and his oral evidence that the clinical failings fell “far below the expected standards”. Furthermore, the Committee had found that Mr Hodge failed to maintain an adequate standard of record keeping, which could affect the ability of the subsequent treating practitioner to provide appropriate and timely interventions. The Committee considers that Mr Hodge’s clinical failings and his failure to adequately deal with Patient A’s complaint were a serious breach of the GDC’s Standards as outlined above.

The Committee determined therefore that, individually and collectively, Mr Hodge’s failings in this case were sufficiently serious that they amounted to misconduct.

Impairment

The Committee then considered whether Mr Hodge’s fitness to practise is currently impaired by reason of his misconduct.


The Committee was mindful of its role to protect the public interest, which includes the need to maintain proper standards of conduct and competence among dental professionals, and to protect patients from risk of harm.

In making its decision the Committee firstly considered whether the failings in this case were capable of being remedied, whether they had been remedied and, finally, whether they were likely to be repeated. It was of the view that the clinical failings were capable of being remedied. However, the Committee noted that Mr Hodge had provided no evidence of remediation. He has not provided an explanation as to why he agreed that his practise had been impaired, nor is there any acceptance as to what his errors were. He has not provided any evidence of remorse into his failings and the harm caused to Patient A. He has also failed to provide evidence of steps taken to ensure that these failings will not happen again. It further noted that he had shown only limited insight into his misconduct, other than his email of 12 August 2021 where he accepts that his fitness to practise was impaired.

The Committee considered therefore that, without any evidence of remediation or full insight, there is a significant risk that Mr Hodge could repeat the misconduct it has found. In the Committee’s view a finding of impairment is necessary in the interests of public protection.

The Committee also determined that a finding of impairment was necessary in the wider public interest to maintain public confidence and uphold proper standards of conduct and behaviour. Mr Hodge’s actions fell far below the required standard in fundamental areas of dentistry and he has shown limited insight into these serious failings.

The Committee concluded that a reasonable and informed member of the public, fully aware of the facts of the case, would lose confidence in the profession and the dental regulator if a finding of impairment were not made in the circumstances of this case.

The Committee therefore determined that Mr Hodge’s fitness to practise is currently impaired by reason of his misconduct.

Sanction

The Committee next considered what sanction, if any, to impose on Mr Hodge’s registration. It recognised that the purpose of a sanction is not to be punitive although it may have that effect. The Committee applied the principle of proportionality balancing Mr Hodge’s interest with the public interest.

The Committee considered the mitigating and aggravating factors in this case.

The mitigating factors in this case include:

• 1st complaint before his regulator in 45 years.

• Evidence of previous good conduct and character

• No financial gain

• Time elapsed since the events complained of.

The aggravating factors in this case include:

• Actual harm to a patient;

• Lack of full insight.

The Committee decided that it would be inappropriate to conclude this case with no further action. It would not satisfy the public interest given the serious nature of the misconduct.


The Committee then considered the available sanctions in ascending order starting with the least serious.

The Committee concluded that misconduct of this nature cannot be adequately addressed by way of a reprimand. It cannot be said to be at the lower end of the spectrum. The likelihood of the misconduct being repeated also means that patients and the public interest would not be sufficiently protected by the imposition of such a sanction. The Committee therefore determined that a reprimand would be inappropriate and inadequate.

The Committee considered whether a conditions of practice order would be appropriate. It noted that the majority of the failings in this case could be addressed by the imposition of conditions. However, in the absence of evidence that Mr Hodge has shown insight into his failings, and in light of his indication that he does not wish to continue practicing as a dentist, the Committee concluded that imposing conditions on Mr Hodge’s practice would not be workable or enforceable.

The Committee then considered whether an order of suspension would be appropriate to mark the nature and severity of the misconduct. It noted in the GDC’s Indicative Sanctions Guidance that suspension is appropriate for more serious cases when:

• The registrant has not shown full insight and poses a significant risk of repeating the behaviour;

• Patients’ interests would be insufficiently protected by a lesser sanction;

• Public confidence in the profession would be insufficiently protected by a lesser sanction.

• There is no evidence of deep-seated personality or professional attitudinal problems (which might make erasure the appropriate order).

While recognising that the failings in this case are serious, the Committee does not consider it to be so serious that Mr Hodge’s conduct is fundamentally incompatible with continued registration. The Committee gave consideration to the option of erasure but determined that such a step would be disproportionate. In coming to that view, the Committee has borne in mind that the misconduct is capable of being remedied and that there was no evidence before it that he had caused serious harm to other patients.

Accordingly, having had regard to all of the evidence, the Committee has determined to direct that Mr Hodge’s registration be suspended for a period of 6 months. This will provide him with an opportuntity to demonstrate adequate insight and reflection into his deficiencies. The Committee has also had regard to the principle of proportionality. The Committee is satisfied that this period of time is sufficient to mark the nature and extent of Mr Hodge’s failings in this case, to uphold professional standards and to maintain public confidence in the profession and the regulatory system.

The Committee also directs that the suspension order be reviewed before its expiry.

The Committee now invites submissions from Ms Price as to whether Mr Hodge’s registration should be suspended immediately.

The Committee has considered whether to make an order for the immediate suspension of Mr Hodge’s registration in accordance with Section 30 of the Dentists Act 1984 (as amended).


Ms Price, on behalf of the GDC, submitted that such an order is necessary for the protection of the public and is otherwise in the public interest given the findings this Committee has determined.

The Committee has considered the submission made by Ms Price. It has accepted the advice of the Legal Adviser.

The Committee is satisfied that an immediate order of suspension is necessary for the protection of the public and is otherwise in the public interest. The Committee concluded that given the nature of its findings and its reasons for the substantive order of suspension in Mr Hodge’s case, it is necessary to direct that an immediate order of suspension be imposed on both of these grounds. The Committee considered that, given its findings, if an immediate order was not made in the circumstances, there would be a risk to public safety and public confidence in the profession would be undermined.

The effect of this direction is that Mr Hodge’s registration will be suspended immediately. Unless Mr Hodge exercises his right of appeal, the substantive order of suspension will come into effect 28 days from the date on which notice of this decision is deemed to have been served on him. Should Mr Hodge exercise his right of appeal, this immediate order for suspension will remain in place until the resolution of any appeal.

That concludes this hearing.”

hearing heard in public hodge, michael george registration

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