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When faced with an investigation by the Irish Dental Council (IDC), as increasing numbers of dental professionals are, good record keeping can really protect a registrant’s position. In many cases good records can make the difference between an early case conclusion and a protracted investigation. Poor record keeping, on the other hand, can let the clinician down when defending the specific allegations as well as leading to the possible scrutiny of their record keeping practices as a whole.
Record keeping, whilst often regarded as a skill that does not need to be revisited during a professional career, can assume a more significant role once a professional is subject to scrutiny by the IDC. So it is worth reading on, even if only motivated by the thought that prevention is preferable to the cure.
The IDC investigation
When a complaint is received by the IDC, a copy of it is sent to the registrant who is requested to furnish his/her observations and comments. It is the usual practice of the Registrar of the IDC to request, at the same time, that the dentist forward a copy of the notes and any x-rays. The matter is then considered by members of the Fitness to Practice Committee of the IDC, made up of dentists and non-dentists, to determine whether there are sufficient grounds for referring the matter to an oral hearing before a differently constituted membership of the Fitness to Practise Committee. It often happens that the initial Committee decides to investigate the matter further, either by seeking further comments from the complainant or some other consideration. This latter consideration may well include the identification of deficiencies in the dentist's
record keeping.
If such failings are picked up, there is potential for the Committee’s concerns and for the case itself to widen, to include not only the issues raised by the initial complainant but also the practices of that dentist as a whole. You can follow the thinking; if this patient’s records are so poor, what are the rest of this dentist’s records like? If their record keeping is so poor, what else are they getting wrong?
Conduct and unfitness to practise
Cases being considered by the IDC under the terms of the Dentists Act 1985 fall into two categories. The first of these is alleged professional misconduct which, in this context, is defined as a serious falling short, by omission or commission, of the standards of conduct expected among dentists. The other category is unfitness to
engage in the practice of dentistry by reason of physical or mental disability.
Where there are concerns about a dentist’s clinical treatment of a single patient, this will be dealt with as a conduct issue but, as we have seen above, such concerns may widen to include the standard of the clinical records.
Identifying concerns
At a dentist’s first meeting with their dento-legal adviser from DPL and a solicitor from the DPL panel, it is important to identify concerns regarding poor record keeping.
For example, DPL recently dealt with a case in relation to concerns that a patient had not been informed of problems with her dentition. The records should have contained detailed notes documenting the discussions between the dentist and the patient.
Unfortunately however, the records not only lacked positive evidence to assist the dentist but also demonstrated further concerns in terms of failing to record treatment planning, medical history and BPE scores.
Dealing with the concerns
Having identified these concerns, the question for the defence team became whether or not to refer to these failings within the response to the allegations, given that they have not (yet) been identified by the IDC as areas of concern. The important factor to bear in mind here is that the Fitness to Practise Committee will consist of experienced dentists and lay individuals who are very accustomed to scrutinising dental records. They will therefore know what to expect and there is little chance that glaring failures will be overlooked. By recognising and addressing the failures however, the clinician can pre-empt the Committee’s concerns and show insight into their failings.
In this particular case the dentist accepted the advice to be up front about the failings, whilst also at the same time setting out evidence of remediation.
Remediation
The Fitness to Practise Committee, in considering whether to refer the matter on to an oral inquiry, must determine whether there is a realistic prospect of the facts alleged being proved beyond reasonable doubt and also that such facts either constitute professional misconduct (as defined above) or that the practitioner’s fitness to practise is likely to be found impaired to such an extent justifying action being taken on their registration. If these tests are both affirmative, the initial Fitness to Practise Committee will refer the case to a differently constituted Committee for an oral hearing.
In addressing the issue of fitness to practise however, the basic question for the IDC is whether the registrant’s fitness to practise is currently impaired ie. at the date of the hearing and not looking back to the date of the patient’s treatment.
All is not doom and gloom therefore where a dentist is prepared to engage with the process and to put changes in place.
The following are examples of steps which can be taken to demonstrate remediation where a dentist’s records are poor:
Light at the end of the tunnel
For a dentist facing a complaint to the IDC, the added complication if poor record keeping can seem like a daunting hurdle to overcome. It is, however, DPL’s experience that engagement with the regulatory process and willingness to institute change can lead to a successful and early resolution. Members can also rest safe in the knowledge that they are meeting the standards required of them and that they have eliminated future record keeping deficiencies.
Based on an article featured in Riskwise Ireland 20