Charge
A Professional Conduct Committee (PCC) laid two charges against Mr Daniel George Sutherland (the Dental Technician).

The first charge alleged that the Dental Technician was guilty of professional misconduct in that he had provided treatment to a patient that he knew or ought to have known were outside his scope of practice as a dental technician.  It further alleged that he advertised his services when he knew or ought to have known that such services were outside his scope of practice and they were restricted activities that he was not permitted to perform.

The second charge alleged that he had practised without a current practising certificate.

Finding
The Tribunal found both charges established and that the Dental Technician was guilty of professional misconduct and failing to hold an APC when practising as a dental technician.

Background
The Dental Technician had advertised for the making and fitting of dentures directly to the public by the following methods:

• a sign in the window of his premises
• printed business cards placed in many local businesses
• customer service cards in supermarkets
• yellow pages advertisements

A patient made an appointment to see the Dental Technician on 23 July 2010 for the purpose of getting an upper denture made and fitted by the Dental Technician.

On that day the Dental Technician came out into the waiting room with a mixed up gooey mixture on a paper towel.  He handed it the patient and told him to push it into the top of his mouth and work it into his gums with his two thumbs. The patient confirmed the Dental Technician did not touch his mouth, or examine him.  However, he did direct the operation of placing the mixed up material in his mouth, and told the patient what he was to do next.
The Dental Technician left the patient to do this for about five minutes, and then returned and told him that would be long enough.  The Dental Technician was not wearing gloves. He took the mould away to another room and created a wax mould, which the patient put in his mouth to test it for size and comfort. 

The patient paid the Dental Technician and arranged when he would pick up the denture.  When he picked up the denture he tried it on and it felt comfortable.

The Tribunal found the Dental Technician did not have a practising certificate for the periods between 1 April to 7 May 2010 and 11 January to 18 April 2011.

Reasons for Finding
Particular 1(a) alleged the Dental Technician took an impression of the patient’s upper mouth for the purpose of manufacturing an upper denture.  The Tribunal found this was established.

Particular 1 (b) alleged the Dental Technician manufactured an upper denture for the patient without having a prescription from a health practitioner.  The Tribunal accepted there was no prescription and that the Dental Technician did manufacture the upper denture. 

Particular 1(c) overlapped the previous two to some extent, by alleging that the Dental Technician directly supplied the patient with the new upper denture that he had manufactured on the basis of the impression of the patient’s mouth, and without a prescription.  These elements were established.
The preamble to the three subparticulars required the Tribunal to be satisfied:

• That the Dental Technician knew or ought to have known he was providing treatment outside his scope of practice as a dental technician.
• That the activities in question were restricted activities that the Dental Technician was not permitted to perform under his scope as a dental technician.
• The Tribunal considered that the Dental Technician was purporting to carry out the activities of a clinical dental technician.  No prescription was provided to him yet he was prepared to take the impression and prepare the new denture.  There was evidence from the Dental Council as to conversations held with the Dental Technician which made it clear that he knew he was not a clinical dental technician but was acting as one. 
• The Tribunal found that he knew he was acting outside of scope of practice as a dental technician.

The Tribunal concluded that particular 1 of the charge was established.  It was satisfied this conduct amounted to malpractice and brought discredit to the profession. 

The Dental Technician deliberately chose to act outside his authorised scope, knowing he was not permitted to do so. 

There was no adherence to hygiene as would normally be expected in respect of a clinical dental technologist. There was no proper examination such as a detailed measurement, or inspection of the mouth for potential disease. There was no evidence that proper notes of clinical consultation were kept. Having regard to these factors, the Tribunal was satisfied that this particular was sufficiently serious as to warrant discipline.

The Tribunal was satisfied that Particular 2 was established in that the Dental Technician did place a number of advertisements between 20 May 2010 and 18 April 2011 which promoted his services in making and fitting dentures directly to members of the public when he knew that such services were outside his scope of practice as a dental technician and/or were restricted activities under the Act that he was not permitted to perform under his scope of practice as a dental technician. The Tribunal was further satisfied that he did in fact provide clinical technology services directly to members of the public.

The Tribunal was satisfied the conduct alleged in particular 2 was established and constituted malpractice and brought discredit to the profession of dental technology.  The Tribunal found it sufficiently serious to warrant discipline, particularly as the offering and conducting of the services went on for so long.

The charge of professional misconduct was established.

When considering charge 2 there was no question, the Dental Technician was conducting an ongoing denture repair operation and therefore practised the profession of dental technology.  Charge 2 was accordingly established.

Penalty

The PCC raised a number of factors which it submitted were aggravating factors, which were broadly accepted by the Tribunal.  In summary those factors were:

• The Dental Technician conducted restricted activities that he was not permitted to perform.  By definition they are the highest risk health services provided by health practitioners. 
• The Dental Technician knew he was not permitted to provide the clinical services he provided.  He deliberately and cynically chose to ignore the requirements, for personal financial gain.  In doing so he put members of the public at significant risk of harm.
• The Dental Technician persisted in providing clinical services even after having been put on clear notice his conduct was being investigated.
• The Dental Technician was repeatedly advised his practising certificate as a dental technician had expired.
• There was an element of dishonesty in the conduct the Tribunal was required to review, that is practising outside of scope and practising without an APC. 
• The Dental Technician refused to engage with the PCC and with the Tribunal.  This demonstrated a significant lack of insight.

The Tribunal considered that the Dental Technician’s practice was so inept that the only possible order which the Tribunal found it could make in these circumstances, having regard to the health and safety of the public and the maintenance of professional standards, was to order cancellation of the Dental Technician’s registration.

The Tribunal further ordered the Dental Technician be censured and pay 50% of the costs of the hearing, a total of $38,000.