HEARING HEARD IN PUBLIC HARATEH, Bashar Registration No ...

HARATEH, B Professional Conduct Committee – March 2017 Page -1/31-

HEARING HEARD IN PUBLIC

HARATEH, Bashar

Registration No: 161678

PROFESSIONAL CONDUCT COMMITTEE

MARCH 2017

Outcome: Erased with Immediate Suspension

Bashar HARATEH, a dentist, Lek Dent Poznan 1993, was summoned to appear before the Professional Conduct Committee on 6 March 2017 for an inquiry into the following charge:

Charge

“That, being a registered dentist,

1. On various dates you provided dental treatment to the patients identified at Schedule 11.

Patient 1

2. Between 7 April 2011 and 11 May 2012, you provided treatment to Patient 1.

3. You failed to provide an adequate standard of care to Patient 1 in that you did not:

(a) undertake any or any adequate orthodontic examination;

(b) identify and/or undertake pre-treatment investigations;

(c) formulate any or any adequate orthodontic diagnosis;

(d) formulate any or any adequate treatment plan;

4. You failed to maintain an adequate standard of record keeping in respect of Patient 1 in that you:

(a) did not record any or any adequate orthodontic examination;

(b) did not record any or any adequate orthodontic diagnosis;

(c) did not record any or any adequate treatment plan;

(d) did not provide and/or keep a written record of the cost of treatment and/or fees paid;

(e) kept records written in Polish which were not clear and/or complete and/or capable of being readily understood.

Patient 2

5. Between 10 November 2011 and 21 June 2012, you provided treatment to Patient 2.


1 The schedule is a private document and is not disclosed to the public.





(d) formulate any or any adequate treatment plan.







Patient 3

8. Between 2 March 2012 and 17 August 2012, you provided treatment to Patient 3.






(e) undertake any or any adequate reassessments and/or reviews of Patient 3’s treatment.






(e) did not record any or any adequate reassessments and/or reviews of Patient 3’s treatment;

(f) kept records written in Polish which were not clear and/or complete and/or capable of being readily understood.

Patient 4

11. Between 7 June 2012 and 3 August 2012, you provided treatment to Patient 4.











(d) did not provide and/or keep a written record of the cost of treatment and/or the fees paid;


14. From 15 May 2014 to date you failed to cooperate with an investigation into the treatment of Patients 1, 2, 3 and 4 in that you did not respond adequately or at all to requests for information.

Patient 5

15. Between 5 February 2014 and 6 July 2015 you provided treatment to Patient 5.

16. At Patient 5’s first appointment on 5 February 2014 you failed to provide an adequate standard of care to Patient 5 in that you did not:

(a) take appropriate steps to satisfy yourself that Patient 5’s general dental condition was suitable for orthodontic treatment before commencing treatment;

(b) undertake any or any adequate orthodontic examination;

(c) identify and undertake pre-treatment orthodontic investigations;

(d) consider the OPG radiograph provided by Patient 5;

(e) formulate an adequate orthodontic diagnosis;

(f) adequately formulate a treatment plan.

17. At Patient 5’s first appointment on 5 February 2014 you inappropriately placed metal braces on her upper teeth.

18. Between 17 March 2014 and 6 July 2015 you failed to provide an adequate standard of care to Patient 5 in that you did not:

(a) adequately review orthodontic treatment carried out at appointments on:

(i) 17 March 2014

(ii) 28 April 2014

(iii) 30 May 2014

(iv) 23 June 2014


(v) 30 September 2014

(vi) 23 December 2014

(vii) 11 March 2015

(viii) 23 March 2015

(ix) 19 May 2015

(x) 30 June 2015

(b) replace the metal braces on Patient 5’s upper teeth with porcelain braces.

19. Between 5 February 2014 and 6 July 2015 you failed to provide an adequate standard of care to Patient 5, in that you did not:

(a) communicate adequately or at all the treatment options, and/or risks and benefits of treatment, and/or an adequate treatment plan;

(b) inform her of her uneven jaw and/or bite and/or dental gap;

(c) provide an adequate explanation for partially placing metal braces when Patient 5 paid for full porcelain braces.

20. Your conduct at 19(a), (b) and (c) above individually and/or taken together was such that Patient 5 underwent treatment without giving fully informed consent.

21. Between 5 February 2014 and 6 July 2015 you failed to maintain an adequate standard of record keeping in respect of Patient 5 in that you did not:

(a) record steps you had taken to satisfy yourself that Patient 5’s general dental condition was suitable for orthodontic treatment prior to commencing treatment;

(b) record any or any adequate orthodontic examination;

(c) record any or any adequate orthodontic diagnosis;

(d) record any or any adequate treatment plan;

(e) record any radiograph findings;

(f) provide and keep a written record of the cost of treatment and/or fees paid;

(g) record adequately or at all the orthodontic treatment carried out at appointments on:

(i) 17 March 2014

(ii) 28 April 2014

(iii) 30 May 2014

(iv) 23 June 2014

(v) 30 September 2014

(vi) 23 December 2014

(vii) 11 March 2015

(viii) 23 March 2015


(ix) 19 May 2015

(x) 30 June 2015

22. Between 5 February 2014 and 6 July 2015 you did not communicate with Patient 5 in a professional manner in that you spoke to her in a rude and angry manner.

23. You did not respond adequately to Patient 5’s complaint, in that you:

(a) refused to discuss her concerns about treatment;

(b) did not provide her with a copy of the Practice complaints procedure when requested.

Indemnity cover

24. You provided dental advice and treatment to patients when you were not in possession of indemnity insurance which covered you to work in the UK for some or all of the following periods:

(a) 28 September 2011 to 27 September 2012.

25. Your conduct at paragraph 24(a) above was dishonest, in that you provided dental advice and treatment to patients when you knew that you:

(a) were required to have appropriate professional indemnity cover in placed if you were to practise dentistry in the UK;

(b) did not have appropriate indemnity cover in place.

Conduct in relation to Patients 3 and 4

26. In respect of Patient 3, you:

(a) inaccurately recorded that you planned a course of treatment using Invisalign aligners; and/or

(b) inaccurately recorded that you received Invisalign aligners.

27. Your conduct at 26(a) and/or (b) above was:

(a) misleading;

(b) dishonest in that:

(i) you did not obtain the Clincheck treatment plan; and/or

(ii) you did not order Invisalign aligners from Align Technologies; and

(iii) in relation to 27 (a) and/or (b), you knew you had not done so.

28. In respect of Patient 4, you:

(a) inaccurately recorded that you planned a course of treatment using Invisalign aligners; and/or

(b) inaccurately recorded that you received Invisalign aligners.

29. Your conduct set out at 28(a) and/or (b) above was:

(a) misleading;

(b) dishonest in that:


(i) you did not obtain the Clincheck treatment plans; and/or;

(ii) you did not order Invisalign aligners from Align Technologies; and

(iii) in relation to 29(a) and/or (b) you know you had not done so.

And by reason of the matters set out above, your fitness to practise is impaired by reason of your misconduct.”

Mr Harateh was not present and was not represented. On 13 March 2017 the Chairman announced the findings of fact to the Counsel for the GDC:

“Ms Bates

Service and proceeding in the absence of the Registrant

Mr Harateh was neither present nor represented at the Professional Conduct Committee (PCC) hearing of his case. In his absence, the Committee first considered whether the Notice of Hearing had been served on him in accordance with Rules 13 and 28 of the General Dental Council (GDC) (Fitness to Practise) Rules Order of Council 2006 (the Rules). In so doing, the Committee has had regard to the service bundle of documents as well as the submissions made by Ms Bates on behalf of the GDC. It has accepted the advice of the Legal Adviser.

The Committee has seen a copy of the Notice of Hearing letter dated 26 January 2017, giving Mr Harateh notice of today’s PCC hearing, which was sent by Capsticks Solicitors, acting on behalf of the GDC, to Mr Harateh’s registered address in Poland by International Signed For Delivery. The letter sets out the date, time and location of today’s hearing, as well as the particularised facts of the charge and the Royal Mail track and trace receipt states that delivery was attempted at Mr Harateh’s registered address on 26 January 2017. It was also sent via secure email to two known email addresses of the registrant on 26 January 2017. Various attempts were also made to contact the registrant via telephone but were unsuccessful. The Committee is satisfied that this letter sets out the information required in accordance with Rule 28 and that it was sent to Mr Harateh’s registered address more than 28 days in advance of today’s hearing, also in accordance with Rule 28. The Committee is therefore satisfied that the requirements of service have been met in accordance with Rule 13 and 28.

Proceeding in absence

The Committee then went on to consider whether to hear this case in the absence of Mr Harateh in accordance with Rule 54. Ms Bates submitted that it would be appropriate and in the public interest to proceed in the absence of Mr Harateh, given that he was aware of the today’s hearing, as well as the charges against him, but has chosen voluntarily not to attend.

The Committee’s attention was drawn to the various emails from Capsticks Solicitors to Mr Harateh concerning the listing of the PCC hearing; it was initially scheduled to take place from 23 May 2016 to 2 June 2016. However, the hearing was postponed in order to allow the registrant, who was not present nor represented, an opportunity to participate at a future hearing. The Committee has seen copies of the emails from Capsticks Solicitors to Mr Harateh regarding its attempts to contact him since the last hearing was postponed on 24 May 2016. The Committee having been satisfied that the Notice of Hearing was served effectively on 26 January 2017, notes that Capsticks Solicitors have made considerable


efforts to contact Mr Harateh, asking him to confirm whether or not he proposed to attend the hearing and/or be represented. No response had been received.

The Committee has considered the submissions made by Ms Bates. It has accepted the advice of the Legal Adviser. It has borne in mind the need for fairness to both parties, the nature of the allegations against Mr Harateh as well as the public interest in the expeditious disposal of this case. The Committee has seen a copy of Mr Harateh’s email dated 9 February 2017 to the GDC’s Hearings Team in which it states “I am not Harateh! Please do not send to this e-mail”. It notes that Mr Harateh has not engaged with the GDC since the last postponement, despite attempts made by Capsticks Solicitors on a number of occasions to engage with him.

The Committee has drawn the inference that Mr Harateh has voluntarily absented himself from these proceedings. The Committee has received no compelling reasons as to why it should adjourn this PCC hearing and indeed there has been no such request from Mr Harateh. Witnesses have made arrangements to give evidence in person and by telephone. There is nothing to suggest that Mr Harateh would attend on a future occasion given his lack of engagement with the GDC. The Committee has also had regard to the public interest as well as Mr Harateh’s own interests in the expeditious disposal of this case, given that the allegations involve matters relating to failings in respect of his treatment of patients in his care. The Committee has decided that it is fair to proceed in the absence of Mr Harateh, in accordance with Rule 54.

Rule 25 joinder application

You, on behalf of the General Dental Council made an application under Rule 25 of the (GDC) (Fitness to Practise) Rules 2006 (the ‘Rules’) to join a set of additional allegations against Mr Harateh to be considered by this Committee. These additional allegations relate to lack of indemnity cover between 28 September 2011 and 27 September 2012, and with regards to Invisalign treatment concerning Patients 3 and 4.

The provisions relating to Joinder are set out in Rule 25(2) of the Rules. So far as is relevant, they are as follows;

“(2) Where

a) an allegation against a respondent has been referred to a Practice Committee,

b) that allegation has not yet been heard, and

c) a new allegation against the respondent which is of a similar kind or is founded on the same alleged facts is received by the Council.

The Practice Committee may consider the new allegation at the same time as the original allegation, notwithstanding that the new allegation has not been included in the notification of hearing.

(3) Where it is proposed that a new allegation should be heard by a Practice Committee under paragraph (2), they shall –

(a) inform the respondent of the new allegation, and the alleged facts on which it is based; and

(b) provide the respondent with an opportunity to make written representations on the new allegation and require any such representations to be received within the


period of 28 days beginning with the date on which notification of the new allegation was sent to the respondent, or within such period as is otherwise agreed by the parties.”

You submitted that the additional allegations were connected to the original allegations and that it would be appropriate for all allegations against the registrant to be heard at the same time.

You guided the Committee to witness statements in support of the charges as well as financial records and indemnity certificates. You stated that the new allegations arise from the same set of facts regarding Mr Harateh’s failure to cooperate with the GDC investigation. You stated that there would be no prejudice in joining these two sets of allegations together.

In relation to the application to join the new allegations, you guided the Committee to correspondence from your instructing solicitors dated 26 January 2017 to Mr Harateh. In that correspondence, your instructing solicitors set out the terms of Rule 25, the reasons why it was considered that a Joinder was appropriate and invited a written response from the registrant. No response was received by Mr Harateh.

The Committee have considered your submissions carefully and accepted the advice of the Legal Adviser regarding the general principles to be taken into account when considering this type of application, as well as the relevant provisions set out in the Rules.

The Committee is satisfied that the new allegations were of similar nature to those contained within the original charge and that they were founded on the same alleged facts. In relation to indemnity cover, the Committee determines that the GDC during its investigation asked the registrant for a copy of his indemnity certificate and is satisfied therefore that there is a connection between the two sets of charges, as they both concern the manner in which Mr Haraeth cooperated with the investigation. In relation to Patient 3 and 4 regarding incorrect recording of Invisalign treatment, the Committee notes the original charges concern allegations of incorrect record keeping regarding Patients 3 and 4. The Committee is satisfied that there is a clear connection within the terms of Rule 25(2) (c).

The Committee is satisfied that Mr Hareteh received sufficient notice of the new allegations, both of which were based on material that had already been provided to Mr Harateh by the GDC. In the circumstances, the Committee decided that there would be no risk of prejudice to the fairness of the proceedings, if it considered the new allegations at the same time as the original allegations. Further, the Committee considered that it would be expeditious and in the public interest to consider all the alleged matters together at one hearing.

The Committee therefore acceded to the Rule 25(2) application and the new allegations were joined to the original charge. The individual heads of charge were numbered accordingly.

Jurisdiction

The Committee noted that some of the treatment that it was considering took place in Poland. You addressed the panel about their jurisdication and submitted that this is dealt with by section 27(3) of the Dentists Act 1984, which says that, where

‘it appears to the Professional Conduct Committee that the question whether an inquiry should be held needs further consideration….it shall be the duty of the Professional Conduct Committee to hold an inquiry into any case referred to them under this section’


The Committee received advice from the Legal Adviser and concluded that the General Dental Council had the duty to regulate the conduct of it’s members, wherever that conduct or alleged misconduct took place.

The Evidence and Record keeping

The Committee first considered the issue of record keeping. Mr Hinman, in his report at paragraph 4.2 set out the guidance in the British Orthodontic Society (Advice Sheet) Orthodontic Records Collection and Management which states

‘Clinical records are used at every consultation and are designed to provide an accurate picture of patient treatment and care. Good clinical records are an important means of communication between different health professionals caring for the patient. Records should be contemporaneous, clear, concise and complete. They have most value when they are accurate, up to date and accessible when needed. The orthodontic clinical record should enable another person to reconstruct your consultations with the patient’

The Committee considered the evidence called by the GDC in respect of the general record keeping of Mr Harateh, as well as the detailed evidence provided by Mr Hinman in respect of the records for each individual patient. The panel noted that the majority of original records were entered in Polish and had been translated for the purpose of this report. It decided that any record which was retained only in Polish would be of no value to another dental professional involved in caring for the patient or in the monitoring of treatment standards. All orthodontists should be sufficiently fluent in written and spoken English to communicate with patients, relatives and the dental teams and should ensure that all documentation that records their work including patient records is clear, contemporaneous, accurate and complete and can be readily understood by others.

The Committee heard and accepted the evidence of SM of Align Technology who confirmed that he had checked the records held by Align in respect of Mr Harateh and confirmed that there were no records held for Patient 3 or Patient 4.

The Committee also accepted the evidence of RM, the practice manager for My Medyk Dental and Dental Centre, who exhibited all of the dental records and financial records for each patient. RM explained that the dental practice of Mr Harateh, formerly known as Medyk Ltd, went into liquidation and was taken over by United Marketing Boutique Ltd T/A My Medyk Dental and Medical Centre [the Practice]. Mr Hareteh worked as a dentist before RM began working at the Practice and RM confirmed to the panel that he had never met Mr Harateh or worked alongside him.

In answer to questions from the panel, RM confirmed that he was aware of the legal obligation to retain all relevant records and that he knew ‘for sure’ that all records were retained and none were destroyed. He accepted full responsibility to ensure that all records were retained and said ‘if we don’t have them they have not been kept’

Mr Hinman also gave evidence to the committee about the general record keeping. He confirmed that he found no evidence anywhere of treatment plans, and confirmed that the majority of records had been held in Polish. He described the records of the Invisalign treatment to Patient 3 as ‘a nonsense. If Invisalign had been used, the Committee would have expected to a series of reviews which were not present here. Mr Hinman was also critical of the detail of treatment provided and explained in the treatment plans. When asked in his view whether or not there could be other records in existence, he explained that there


would be in his opinion, no purpose in keeping a second set of handwritten notes, and all notes were kept on the computers, which had been thoroughly interrogated.

The Committee concluded that, based upon the entirety of the evidence, the records that had been maintained by Mr Harateh were inadequate and written in Polish, and could therefore not be properly described as being clear, contemporaneous, accurate or complete and they could not be readily understood by others.

In considering the allegations against Mr Harateh, the Committee has had regard to all the evidence before it, both documentary and oral. This includes the GDC’s main prosecution bundle which contains the dental records for Patients 1-5, signed witness statements of LC, SM, RM. It also had sight of a written response from the registrant.

The Committee heard oral evidence on behalf of the GDC from Patient 5, and also from RM, Practice manager for My Medyk Dental and Dental Centre.

The Committee found the oral evidence of Patient 5 to be credible and clear in her recollection of events. With regards to Mr RM, the Committee also found his oral evidence to be credible and honest.

The Committee received expert evidence from Mr Hinman (called on behalf of the GDC). He produced expert reports dated February 2015 and 29 December 2016. Mr Hinman also gave oral evidence at the hearing and the Committee considered that he was fair and balanced in his views. His evidence was credible, clear and concise.

The Committee received advice from the Legal Adviser in relation to dishonesty which was alleged in Charge 26. He advised the Committee to apply a two-stage R v Ghosh [1982] Q.B. 1053 . This was as follows:

First, to decide whether, according to the ordinary standards of reasonable and honest dentists, what was done was dishonest. If it was not dishonest by those standards, that is the end of the matter and the prosecution fails.

Second, if it was dishonest by those standards, whether the dentist himself must have realised that what he was doing was, by those standards, dishonest. He advised that the important aspect of the second limb of the test was that the Registrant could not set his own standards of honesty.

The Committee considered all the evidence presented to it. It took account of the submissions made by Ms Bates on behalf of the GDC. It considered each head of charge separately, bearing in mind that the burden of proof rests with the GDC and that the standard of proof is the civil standard, that is, whether the alleged facts are proved on the balance of probabilities.

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

1. Proved.

The Committee having checked the patient 1 records and cross referenced the financial records is satisfied that Mr Hareteh provided treatment to patients identified in the schedule on these dates.

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2. Proved.

The Committee having checked the patient 1 records and also cross referenced the financial records is satisfied that Mr Hareteh provided treatment to Patient 1 on these dates.

3. (a) Proved.

The Committee found no evidence to demonstrate that Mr Harateh had taken any adequate orthodontic examination in respect of Patient 1. Patient 1’s notes make reference specifically to Invisalign treatment only. The GDC expert, Mr Hinman stated that there was no point in conducting an examination if it was not properly recorded because patients and another dental professional would not know the precise details of what had taken place. Taking into account all the evidence, the Committee considers that on the balance of probabilities an adequate examination did not take place.

3. (b) Proved.

The Committee would expect to see some justification for taking a radiograph or the reasons for not requiring a radiograph. The Committee would also expect to see notes of orthodontic assessments and study casts undertaken. The Committee found no record made of this in Patient 1’s notes, nor any indication in Patient 1’s notes that it was a pre-treatment investigation.

3. (c) Proved.

The Committee having considered the records and Mr Hinman’s comments on the necessity of formulating an adequate diagnosis concluded that charge 3(a) was made out. The Committee noted Mr Hinman observations about the consequences of failing to adequately record an examination.

3. (d) Proved

The Committee noted and accepted the observations in Mr Hinman’s report setting out what is required in a treatment plan.

The Committee considers that having found charges 3a, b and c proved, it is more than likely that Mr Harateh would not be in a position to formulate any adequate treatment plan. It notes that the records make reference to Invisalign, but Mr Harateh did not make reference to any Clincheck assessment or recommendations. The Committee is satisfied that this does not constitute an adequate treatment plan.

4. (a) Proved.

The Committee having found proved that Mr Hareteh did not make an adequate orthodontic examination is satisfied that he could not have been in a position to make a record of this. The


Committee found no record in Patient 1’s notes.

4. (b) Proved.

The Committee having found proved that Mr Hareteh did not make an adequate orthodontic diagnosis is satisfied that he did not make a record of this. The Committee found nothing in Patient 1’s notes.

4. (c) Proved.

The Committee having found proved that Mr Hareteh did not provide an adequate treatment plan is satisfied that he did not make a record of this. The Committee found although there was a reference to Invisalign, the Committee agreed with Mr Hinman’s comments in his report that this does not constitute a written treatment plan.

4. (d) Proved.

The Committee noted that there were different sections in the computer system for clinical treatment and payments made. The Committee had sight of the written record of the fees paid for this patient. However, the Committee was unable to match up the payments with specific areas of treatment provided. The Committee considered that when a patient has treatment a discussion must take place involving an estimate of costs.

Mr Hinman stated in his report that…“ if things changed along the way then adjustments should be made as to the costs involved”. He stressed the importance of letting the patient know of costs in advance.

The Committee acknowledge that there was a record in a separate system of the fees paid, however the Committee considered that a written record of cost of treatment had not been provided in the clinical notes. The Committee is satisfied it this is not an adequate written record of the costs of treatment.

4. (e) Proved.

The Committee has had sight of the Polish records. The Committee note the opinion in Mr Hinman’s report which states that “the registrant in failing to produce clear, contemporaneous records that can be readily understood by others provided an inadequate standard of care…” He also states that “It is evident from above that the records are in Polish and the clinical record was inadequate”.

The Committee notes that the records are extremely sparse and is satisfied that the records were not clear, complete and not capable of being readily understood. It also considers that a failure to keep full and accurate records undermines the purpose of record keeping.


5. Proved.

The Committee having checked the records of patient 2 and cross referenced the financial records is satisfied that Mr Hareteh provided treatment to Patient 2 on these dates.

6. (a) Proved.

The Committee notes that the records only make refence to a “check-up”. The Committee consider that this could mean anything, and therefore this is does not constitute an adequate orthodontic examination.

The Committee accepted Mr Hinman’s evidence that “there is no evidence within the clinical record that the registrant made a written record of any orthodontic examination.”

6. (b) Proved.

The Committee noted in the records of Patient 2 that an entry was made on 31 October 2011 indicating that an OPG radiograph was obtained. However, the Committee was not shown the radiograph and there is no evidence that Mr Harateh had reported on the radiograph prior to commencement of the orthodontic treatment. There is no mention in the notes of any study casts taken.

The Committee noted that there appears to be some indication in the patient notes of pre-treatment investigations taken in 2011, based on references to kodak images. Although an OPG had been taken by another practitioner and is recorded in the notes, this was not to referred to by Mr Harateh. The Committee considers that this falls short of an adequate pre-treatment investigation.

The Committee found no evidence in the patient notes that pre-treatment study casts and impressions had been taken. Mr Hinman supports this view. The Committee is satisfied, based on the balance of probabilities, that although Mr Harateh had undertaken some pre-treatment investigations it was not adequate.

6. (c) Proved.

The Committee saw nothing in patient notes that constituted an orthodontic diagnosis. This was supported in Mr Hinman’s report which states that “the absence of records made an assessment of the clinical aspects of the orthodontic diagnosis and treatment impossible”.

6. (d) Proved.

Having found charges 6 (a) (b) and (c) proved the Committee is satisfied that Mr Harateh did not formulate any adequate treatment plan. It concluded that it would not be possible to


formulate a treatment plan without an orthodontic examination. The Committee did not find in the patient notes any record of a treatment plan.

7. (a) Proved.

The Committee having found proved that Mr Hareteh did not make an adequate orthodontic examination is satisfied that he did not make a record of this. The Committee found no record of an orthodontic examination in Patient 2’s notes.

7. (b) Proved.

The Committee having found proved that Mr Hareteh did not make an adequate orthodontic diagnosis, is satisfied that he did not make a record of this. The Committee found no record of any adequate orthodontic diagnosis in Patient 2’s notes.

7. (c) Proved.

The Committee having found proved that Mr Hareteh did not make an adequate treatment plan, is satisfied that he did not make a record of this. The Committee noted Mr Hinman’s comments in his report that what was contained in Patient 2’s notes did not constitute an adequate treatment plan.

7. (d) Proved.

The Committee noted that a record of the fees paid by Patient 2 was kept, however, the Committee considered that this was not an adequate standard of record keeping. Mr Hinman stated that a dentist should have provided the patient with a written copy of the treatment plan and costs and this should have been issued to the patient prior to the commencement of orthodontic treatment on 5 January 2012.

7. (e) Proved.

For the same reasons as given in charge 4(e).

8. Proved.

The Committee having checked the records of patient 3 and cross referenced the financial records, is satisfied that Mr Hareteh provided treatment to Patient 3 on these dates.

9. (a) Proved.

The Committee found no evidence to demonstrate that Mr Harateh had undertaken any adequate orthodontic examination in respect of Patient 3. The Committee note that although there were observations in the notes when the teeth had been examined, it considered that this did not amount to an adequate orthodontic examination.

9. (b) Proved


The Committee noted that there were no study casts available for Patient 3 which is an important diagnostic record in treatment planning. Mr Hinman in his report stated that he expected to see pre-treatment investigations to be written up. The Committee is satisfied based on the sparse notes before it that no pre-treatment investigation had taken place.

9. (c) Proved.

The Committee have considered the records of Patient 3. Based on the entry of 2 March 2012, although there is some vague record of a diagnosis, the Committee considers that this was not an adequate diagnosis.

It also considered Mr Hinman’s report which states that “in the absence of any evidence to indicate that the registrant carried out any or any adequate patient interview, clinical examination or used any appropriate diagnostic records, I can only conclude that the registrant could not and therefore did not formulate a proper orthodontic diagnosis”.

The Committee is therefore satisfied that no orthodontic diagnosis was formulated.

9. (d) Proved.

The Committee decided that if Patient 3’s notes are to be considered to be an adequate treatment plan, much more information would be required. Having found charges 9 (a) (b) and (c) proved it is satisfied that Mr Harateh did not formulate any adequate treatment plan. The Committee considered that an orthodontic examination is a necessary component to be able to formulate an adequate treatment plan.

9. (e) Proved.

Mr Hinman’s opinion in his report stated the necessity of undertaking an adequate reassessment and/or reviews.

The Committee found no record in Patient 3 notes of assessment or review. This was supported by the opinions of Mr Hinman in his report.

10. (a) Proved.

The Committee accepted Mr Hinman’s evidence of what should be included in the records for an orthodontic examination. The Committee note that there is a record of orthodontic observations, however, the Committee consider that this was not a thorough and adequate orthodontic examination.

10. (b) Proved.

The Committee noted that in Patient 3’s notes, that there was a reference to a cross bite, but the Committee considered this not


to be a fully-fledged diagnosis. Therefore, the Committee decided that this was not an adequate diagnosis.

10. (c) Proved.

The Committee found no adequate record that would constitute a treatment plan in Patient 3’s notes. There was no record of the aims of the proposed treatment, necessity or otherwise of tooth extraction and planned tooth movements. The Committee accepted the evidence of Mr Hinman which stated that there was no record made of a treatment plan.

10. (d) Proved.

The Committee noted a record of the fees paid by Patient 2 was kept, however, the Committee concluded that this was not an adequate standard of record keeping. Mr Hinman stated that a patient should have been provided with a written copy of the treatment plan and costs and this should have been issued to the patient prior to the commencement of orthodontic treatment.

10. (e) Proved.

The Committee found no record in Patient 3’s notes to confirm this.

10. (f) Proved.

For reasons as given in charge 4(e).

11. Proved.

The Committee having checked the records of patient 4 and cross referenced the financial records is satisfied that Mr Hareteh provided treatment to Patient 4 on these dates.

12. (a) Proved.

The Committee found no evidence to demonstrate that Mr Harateh had undertaken any adequate orthodontic examination in respect of Patient 4.

The Committee accepted the evidence of Mr Hinman who stated in his report that “there is no evidence within the clinical record that the registrant made a written record of any orthodontic examination…” Taking all of this into account, the Committee is satisfied, that on the balance of probabilities, that Mr Harateh did not undertake an adequate orthodontic examination.

12. (b) Proved.

The Committee would have expected to see some justification for taking radiographs or the reason for not requiring a radiograph. The Committee would also have expected to see notes of orthodontic assessments and study casts undertaken.


The Committee having carefully examined the notes of Patient 4, found no record made of this, nor any indication in Patient 4’s notes that there was any pre-treatment investigation.

12. (c) Proved.

The Committee having considered Patient 4’s records, found no record of an adequate orthodontic diagnosis.

12. (d) Proved.

The Committee notes that the word “plan” did appear in Patient 4 notes. However, the Committee did not consider this to be an adequate treatment plan. The Committee is satisfied that Patient 4’s records lack sufficient detail.

13. (a) Proved.

The Committee is satisfied that there is no record made of an adequate orthodontic examination.

13. (b) Proved

The Committee is satisfied that there is no record made of an adequate orthodontic diagnosis.

13. (c) Proved.

The Committee noted the word ”planned” which refers to some type of aligners, However, it does not accept this as an adequate treatment plan.

13. (d) Proved.

The Committee noted that a record of the fees paid by Patient 4 was kept, however, the Committee consider that this was not an adequate standard of record keeping. Mr Hinman stated that a dentist should have provided the patient with a written copy of the treatment plan and costs and this should have been issued to the patient prior to the commencement of orthodontic treatment.

13. (e) Proved.

For the reasons as given in charge 4(e).

14. Proved.

The Committee noted that there is a duty on all registrants to cooperate fully with their regulatory body. Although English was not his first language, Mr Harateh has worked in this country and could have sought assistance in this respect. This does not excuse his failure to cooperate with the GDC. The Committee noted that it is a registrants responsibility to keep the GDC informed of any change in address.

The witness statement of LC, a GDC Casework Manager


confirms that various attempts were made by the GDC to contact Mr Harateh, who failed to adequately respond fully and in a timely manner

The Committee noted that although Mr Hareteh did not comply with the deadlines for a response, they were partial responses containing some documentation. The Committee is satisfied that Mr Haraeth had a duty to co-operate with his regulatory body, and had failed to do so.

15. Proved.

The Committee having checked the records of patient 5 and her written statement is satisfied that Mr Hareteh provided treatment to Patient 5 on these dates. This was confirmed in Patient 5’s notes.

16. (a) Proved.

The Committee agreed with the evidence of Mr Hinman that there was no evidence to confirm that the registrant took any appropriate steps to investigate whether there was caries in Patient 5’s mouth and also the periodontal status of Patient 5. This was supported in oral evidence by Patient 5, who stated that the registrant had not asked any relevant questions and immediately rushed into providing treatment.

The Committee concluded that Mr Harateh had failed to take appropriate steps in ensuring Patient 5 was suitable for orthodontic treatment.

16. (b) Proved.

The Committee accepted the oral evidence of Patient 5 that no orthodontic examination took place. Patient 5 stated in oral evidence that within 5 minutes of her first appointment with him, Mr Harateh was already fitting a fixed appliance to her teeth.

16. (c) Proved.

The Committee noted the omission in Patient 5’s records of any examination, study models or radiographs being taken. This was supported by Patient 5 in her oral evidence who stated that he just looked in her mouth and took photographs and that the appointment was very short in length. Given the short amount of time taken, the Committee concluded that the registrant failed to undertake any pre-treatment orthodontic investigations.

16. (d) Not proved

Patient 5 stated in oral evidence that “I gave him the OPG radiograph and he just looked at the radiograph but didn’t say anything”. The Committee is satisfied that during the first appointment an OPG radiograph was handed to him and that he did look at this. Although he did not record this, the


Committee concluded on the balance of probabilities that he did consider the OPG radiograph.

16. (e) Proved.

The Committee acknowledged that some record was made of a diagnosis. However, the Committee concluded that there is not sufficient detail to constitute an adequate orthodontic diagnosis.

16. (f) Proved.

The Committee noted that reference was made to planning a permanent “porcelain device” in the records of Patient 5. However, the Committee was satisfied that this does not constitute an effective detailed plan. This is supported by the findings in Mr Hinman’s report which states that…” the entries do not provide evidence of sufficient planning”

Patient 5 stated in oral evidence that he continually refused to discuss the options and he stated that she should “just trust me”. The Committee was satisfied that Mr Harateh failed to adequately formulate a treatment plan.

17. Proved.

The Committee noted that Patient 5 had paid over £1000 for porcelain braces and the notes make reference to porcelain braces being proposed, and that she wasn’t expecting any metal brackets on her teeth. The Committee concluded on the basis of Mr Hinman’s evidence that the placing of some metal brackets on Patient 5’s teeth was inappropriate because there was no evidence that metal brackets were required, no adequate explanation of the treatment that he had provided, and there was no evidence that Patient 5 had consented to this.

18. (a) (i) Proved.

18. (a) (ii) Proved.

18. (a) (iii) Not Proved.

The Committee is satisfied that there is nothing in the original notes to indicate that treatment was provided on 30 May 2014. Page 101 tab 2 there is a reference at the foot of the page of Patient 5 notes, to an appointment on 30 September 2014. The Committee is satisfied this may have been mistakenly listed in the charge as 30 May 2014, Patient 5’s witness statement and oral evidence did not refer to an appointment on this date.

18. (a) (iv) Proved.

18. (a) (v) Proved.

18. (a) (vi) Proved.


18. (a) (vii) Proved.

18. (a) (viii) Proved.

18. (a) (ix) Proved.

18. (a) (x) Proved.

In respect of charges 18. (a) (i), (ii), (iv) – (x) - The Committee considers that the notes for these dates do not contain any mention of oral hygiene and tooth movements which are required for an adequate orthodontic review.

The Committee accepted the evidence of Mr Hinman who stated in his report that…”an examination of the clinical notes fails to provide any evidence that the Registrant adequately reviewed the progress of treatment at any time…also there is no evidence of any tooth movement requiring modification to the archwires or attachment..”

The Committee is satisfied that Mr Harateh had failed to adequately review Patient 5’s orthodontic treatment carried out on the above appointments.

18. (b) Proved

The Committee noted Patient 5’s witness statement and also her oral evidence which stated that she wanted a porcelain brace and felt uncomfortable with the metal brace, but stated that Mr Hareteh refused to discuss this and was unpleasant. She stated that he was not able to change the brace at that appointment and would do this later.

The Committee noted from Mr Hinman’s evidence that whilst there may be occasions that metal braces are indicated over porcelain ones, he could see no indication for this from Patient 5’s photos. As Patient 5 had paid for full porcelain braces, the metal brackets should have bene replaced.

The Committee noted Mr Hinman’s report which stated that he expected the metal braces to be replaced with porcelain during the 18-month period.

The Committee was satisfied that Mr Harateh’s attitude was unhelpful every time Patient 5 attended his practice with a request to have the braces changed. The Committee was satisfied that Mr Hareteh failed to replace the metal braces with porcelain braces.

19. (a) Proved.

The Committee accepted the evidence of Patient 5 who in her witness statement stated “I can confirm that Mr Harateh did not explain to me what this ongoing treatment would entail…”.Patient 5 also stated in oral evidence every


appointment was always very short and she felt that she was being rushed. She estimated each appointment was 5-10 minutes, and that Mr Harateh had stated that she didn’t need a treatment plan.

The Committee found no evidence in the Patient 5’s clinical notes of any treatment options, risks and benefits and a treatment plan. The Committee noted that the appointments were very short and was satisfied that there was not sufficient time for Mr Hareteh to communicate adequately with Patient 5 as regards to treatment.

19. (b) WITHDRAWN

19. (c) Proved

Patient 5 in oral evidence and also in her written statement stated that on a number of occasions when she saw Mr Harateh, she raised this issue and at no time did he explain his reasons for not providing a porcelain brace.

20. Proved.

The Committee accepted the evidence of Patient 5 who stated in oral evidence that Mr Harateh was rude to her when she questioned the use of a metal brace and had shown her the door when she refused to sign the patient record sheet. She stated that he told her “it’s my practice and I can do what I want..”. Patient 5 stated that she constantly asked for an explanation and on each occasion he refused to provide one.

The Committee also accepted the evidence of Mr Hinman who stated in his report that to give fully informed consent, it is necessary to give a diagnosis and a treatment plan, and the reasons for giving one course of treatment over another.

The Committee found no evidence in the notes to indicate that a discussion had taken place and therefore finds this charge proved.

21. (a) Proved.

There is nothing recorded in the notes of Patient 5’s suitability for orthodontic treatment.

21. (b) Proved.

For the same reasons given in charge 21. (a).

21. (c) Proved.

For the same reasons given in charge 21. (a).

21. (d) Proved.

There is nothing in Patient 5’s notes to indicate an adequate


treatment plan.

21. (e) Proved

The Committee noted that Patient 5 had brought her OPG with her on the first appointment. However, there is nothing in the notes to indicate any radiographic findings.

Mr Hinman stated in his report “there is no evidence of any report in connection with the dental panoramic radiographs dated 5 February 2014 and taken at another centre prior to the orthodontic consultation”.

The Committee concluded that no analysis was recorded by Mr Harateh of the radiographs.

21. (f) Proved.

Patient 5 stated in oral evidence that she was never offered a treatment plan with costs. The Committee would expect this to be given on the first appointment.

21. (g) (i) Proved.

21. (g) (ii) Proved.

21. (g) (iii) Not proved.

The Committee is satisfied that there was not an appointment on this date. The Committee is satisfied that there is nothing in the notes to indicate that treatment was provided on 30 May 2014. In particular, page 101 tab 2 there is a reference at the foot of the page of Patient 5 notes, to an appointment on 30 September 2014. The Committee concluded this may have been mistakenly listed in the charge as dated 30 May 2014. Patient 5’s witness statement and oral evidence did not refer to an appointment on this date.

21. (g) (iv) Proved.

21. (g) (v) Proved.

21. (g) (vi) Proved.

21. (g) (vii) Proved.

21. (g) (viii) Proved.

21. (g) (ix) Proved.

21. (g) (x) Proved.

The Committee is satisfied that although some record has been made, it does not consider that this constitutes an adequate record.

22. Proved.

The Committee accepted the evidence of Patient 5 who stated


in oral evidence stated that Mr Hareteh was unpleasant when she asked questions and that he appeared very angry during the second appointment and was dismissive. Patient 5 stated that this was not how she expected to be treated.

The Committee also accepted the evidence of Mr Hinman who states in his report “this information (witness statement of Patient 5) does appear to provide evidence that the Registrant continually communicated with Patient 5 in an unprofessional manner”.

23. (a) Proved.

The Committee is satisfied that the notes of Patient 5 do not contain any recording of any discussion relating to her concerns. Patient 5 stated in oral evidence that he continually refused to acknowledge her concerns and failed to provide her with an explanation. Patient 5 stated in her witness statement that he said to her it was his practice and he could do what he liked.

23. (b) Not proved.

The Committee having looked carefully at the wording of this charge cannot find any evidence that an actual request was made.

During Committee questions, Patient 5 stated that she was intending to make a complaint, however she confirmed that she did not ask for a copy of the Practice complaints procedure.

24. (a) Proved.

The Committee had sight of an indemnity certificate provided by Mr Harateh clearly stating the territorial extent of the insurance cover. However, this certificate was not for the relevant period. The certificate provided for the relevant period was silent as to territorial extent.

The policy that covered this relevant period did not have a section on territorial cover and the Committee inferred that it did not provide cover outside Poland. The Committee notes that Mr Harateh failed to provide confirmation of indemnity insurance in a timely manner to the GDC despite a number of requests. He had various opportunities to do so.

The Committee noted Mr Harateh’s email to the GDC dated 18 May 2016, where he gave an explanation that it was his understanding that his employer would provide this.

The Committee was satisfied that Mr Harateh had an obligation to ensure that appropriate indemnity cover was in place. Taking all the evidence into account, the Committee concluded that on the balance of probabilities, he was not in possession of


adequate indemnity insurance.

25. (a) Not proved.

25. (b) Not proved.

The Committee noted the content of Mr Harateh’s email of 18 May 2016 to the GDC, stating that he was aware of his obligation to provide valid indemnity insurance, but failed to do so due to a misunderstanding. The Committee was satisfied that the GDC had not provided any clear and cogent evidence to support their case that his actions were dishonest. The Committee decided that the only safe inference to draw was that Mr Harateh had assumed that his employer intended to provide insurance cover. Although the Committee considered that a careful dental professional would have satisfied himself that cover was in place, it was not satisfied that the GDC had proved to the satisfactory standard that his actions in failing to obtain cover were dishonest.

Taking all of this into account, the Committee is satisfied that his actions were not dishonest.

26. (a) Proved

26. (b) Proved.

For charges 26(a) and (b) - The Committee were satisfied that no Invisalign aligners were provided to Patient 3 by Mr Harateh and concluded that he should not have used the brand name Invisalign when he was using a different brand as he had confirmed in correspondence to the GDC.

The Committee had sight of evidence from the Align Technology that no order was placed and was satisfied that Mr Harateh inaccurately recorded that he had received Invisalign aligners.

27. (a) Proved.

The Committee had sight of evidence from Align Technology that no order was placed. The Committee considered that if a subsequent treating dentist had to take over his treatment, they would think that Invisalign was being used. The Committee also considered that the patient would also be misled in thinking they had this expensive product when in reality they had something else. The Committee was satisfied that Mr Harateh wrote down a different brand in the notes, which was unhelpful to the patient.

The Committee was therefore satisfied that Mr Harateh’s conduct in this respect was misleading.

27. (b) (i) Proved.


27. (b) (ii) Proved.

27. (b) (iii) Proved.

For charges 27.(b)(i) – (iii) - The Committee considered whether the recording of the incorrect brand name was a careless act or one that was dishonest. It considered all the evidence before it and was satisfied that there was a pattern of behaviour of Mr Harateh repeating the same errors. The Committee considered that Mr Harateh had opportunities to acknowledge and correct these errors but failed to do so. Mr Harateh stated in correspondence to the GDC that he used a different system. The Committee noted that the clinical notes and record of payments record that the Invisalign system was used. The Committee noted that whilst the payment system was a separate system he was clearly responsible for the clinical notes.

Mr Hinman confirmed in his report that Invisalign is a market leader and is an expensive product. The Committee accepted the written evidence of SM, Vice President of Align Technology who confirms that there are no records held for Patient 3.

The Committee concluded that it is safe to infer that Mr Harateh had charged Patient 3 for Invisalign, an expensive product knowing that he had supplied a different product and service. The Committee is satisfied that this must have been a deliberate and dishonest decision.

The Committee concluded that a reasonable honest person would, on consideration of all the evidence, consider that Mr Harateh’s actions were dishonest. There was no suggestion here from Mr Harateh that he was entitled to describe the product that he sold as Invisalign. The Committee concluded that his actions were dishonest. Accordingly, charges 27 (b) (i), (ii) and (iii) are found proved.

28. (a) Proved

28. (b) Proved.

For charges 28(a) and 28. (b) - The Committee has seen evidence in notes of Patient 4 that Invisalign aligners were to be used and the Committee also had sight to the reference to the receipt of the upper and lower Invisalign alignment.

The Committee is satisfied that no Invisalign aligners were received or provided to Patient 4. Mr Hareteh himself confirmed in correspondence to the GDC that he had used another brand. The Committee considered that it was not acceptable to record one brand name when Mr Hareteh was using another.

The Committee had sight of evidence from the Align Technology that no order was placed and is satisfied that Mr


Harateh inaccurately recorded that he had received Invisalign aligners.

29. (a) Proved.

The Committee had sight of evidence from Align Technology that no order was placed. The Committee were concerned that a dentist taking over his treatment would think Invisalign was being used. The patient would also be misled in thinking they had this expensive product when in reality they had something else.

The Committee was satisfied that Mr Harateh had misled the patient by writing down a different brand name in the notes and was therefore satisfied that his conduct in this respect was misleading.

29. (b) (i) Proved.

29. (b) (ii) Proved.

29. (b) (iii) Proved.

For charges 29.(b)(i) – (iii) - The Committee considered whether the recording of an incorrect brand name was a careless act or one that was dishonest. It considered all the evidence before it and was satisfied that there was a pattern of behaviour of Mr Harateh repeating the same errors. The Committee considered that Mr Harateh had opportunities to acknowledge and correct these errors but failed to do so. Mr Harateh stated in correspondence to the GDC that he used a different system. The Committee noted that the clinical notes and record of payments record that the Invisalign system was used. The Committee noted that whilst the payment system was a separate system he was clearly responsible for the clinical notes.

Mr Hinman confirmed in his report that Invisalign is a market leader and is an expensive product. The Committee accepted the written evidence of SM, Vice President of Align Technology who also confirmed that there were no records held for Patient 4.

The Committee concluded that it was safe to infer that Mr Harateh had charged Patient 4 for Invisalign, an expensive product, knowing that he had supplied a different product and service. The Committee is satisfied that this must have been a deliberate and dishonest decision.

The Committee concluded that a reasonable honest person would, on consideration of all the evidence, consider that Mr Harateh’s actions were dishonest. There was no suggestion here from Mr Harateh that he was entitled to describe the product that he sold as Invisalign. The Committee concluded


that his actions were dishonest. Accordingly, charges 29 (b) (i), (ii) and (iii) are found proved.

We move to Stage Two.”

On 14 March 2017 the Chairman announced the determination as follows:

“Background

This case concerned the standard of care and treatment provided by Mr Harateh to Patients 1-5 between April 2011 and July 2015. Except for paragraphs 16(d), 23(b), 25(a) and 25(b), the Committee found the remaining heads of charge proved.

Decision on Misconduct

The Committee bore in mind that the decisions on misconduct and impairment were matters for its own independent judgement. It first considered whether the facts found proved amounted to misconduct.

The Committee found proved numerous clinical and attitudinal failings, covering a broad spectrum of areas of dentistry and spanning a considerable period of almost 4 years. Mr Harateh clinical failings included inadequate dental examination of patients; failure to undertake any adequate orthodontic examinations or pre-treatment investigations; failure to formulate any adequate orthodontic diagnosis or treatment plans; failure to undertake any reassessments and/or reviews; poor treatment planning; a failure to maintain adequate record keeping.

In addition, the registrant also failed to communicate adequately with Patient 5, and failed to obtain her fully informed consent. Patient 5, in her oral evidence, repeatedly asked for porcelain braces, but Mr Harateh refused to provide an explanation for using metal braces and failed to replace them despite the fact that Patient 5 had paid £1000 for porcelain braces. In addition, the registrant’s behaviour was rude and angry which caused Patient 5 considerable distress at the time. Mr Harateh also failed to adequately respond to Patient 5’s complaint.

The Committee made findings of misleading and serious dishonest conduct by the registrant. These included inaccurately recording a planned course of treatment using Invisalign aligners in respect of Patients 3 and 4. Finally, Mr Harateh failed to provide adequate indemnity cover for a period when he was treating patients in the United Kingdom and failed to cooperate with a GDC investigation.

The Committee considered that these involve wide ranging failures, dishonest behaviour and failure to engage with his regulatory body. There are clinical and non-clinical failings which were repeated on a number of occasions over a protracted period, involving poor communication towards patients, and also displaying a poor professional attitude towards Patient 5. The Committee noted that there appears to be a common theme of inadequate record keeping. The Committee also noted that Mr Hinman’s reports state that a number of these failings fell far below the standards expected. The Committee considered that his dishonest conduct was motivated by financial gain having supplied Patients 3 and 4 who had paid for Invisalign aligners with a different product.

The Committee was of the view that Mr Harateh’s failure to assist his professional body in its investigations was a serious falling below the professional obligations incumbent upon him.


Mr Harateh’s failings were a serious departure from the standards of conduct expected from a dental practitioner, and fell seriously short of what would be expected in the circumstances and would be considered as thoroughly disapproved by fellow dental practitioners. Mr Harateh’s conduct fell far below a number of standards of the profession – Standards for the Dental Team (September 2013):

Principle 1 – Put patients’ interest first, in particular standards 1.1-1.3.

Principle 2 – Communicate effectively with patients, in particular standards 2.1 – 2.4

Principle 3 – Obtain valid consent

Principle 4 – Maintain and protect patients’ information – 4.1

Principle 5 – Have a clear and effective complaints procedure – 5.1-5.3

Principle 7 – Maintain, develop and work within your professional knowledge and skills, in particular standard 7.1

Principle 9 – Make sure your personal behaviour maintains patients’ confidence in you and the dental profession, in particular standards 9.4.

The Committee bore in mind that a breach of rules or guidance did not automatically lead to a finding of misconduct. However, the Committee considered that the wide-ranging nature and seriousness of Mr Harateh’s failings amounted to serious misconduct.

The Committee was in no doubt that the facts found proved are serious and amounted to misconduct.

Decision on Impairment

The Committee next considered whether Mr Harateh’s fitness to practise is currently impaired by reason of his misconduct. It carefully considered the GDC’s Guidance for the Practice Committees, including Indicative Sanctions Guidance (October 2016) (“the PCC Guidance”).

The Committee considered whether there were any aggravating and/or mitigating factors. In mitigation, it could be said that there was no evidence of clinical harm to patients and that Mr Harateh had a good regulatory record until now. The aggravating features were that these were wide-ranging issues which took place over a four-year period and that the dishonesty related to taking a financial advantage over his patients by providing a clear aligner system instead of Invisalign.

The Committee considered that Mr Harateh has demonstrated poor professional judgment through his conduct and noted his lack of engagement and cooperation with the GDC. The Committee was aware that dishonesty is an attitudinal matter and therefore it is harder to demonstrate remediation than with clinical failings. However, there is no evidence to show that he has an understanding of why his actions were inappropriate and no assurance that he had learned from these proceedings and would not repeat his misconduct. The Committee also considered that he has demonstrated a cavalier attitude towards his regulator and the standards that are expected of a professional.

The Committee had before it no information from Mr Harateh that he has taken any steps to remedy his conduct or that he had any recognition that his conduct was inappropriate. Further, there appears to be no appreciation by the registrant of the seriousness of his misconduct. There is no information before the Committee of any insight by Mr Harateh into


the failings identified by the Committee and no evidence of any remorse for his dishonest misconduct. Given the lack of information from Mr Harateh regarding any remediation or insight, the Committee is satisfied that the risk of repetition is highly likely.

The Committee accepted that English is Mr Harateh’s second language and to fully understand this process may be difficult at times. Nevertheless, the Committee considers that all registrants are duty bound to engage appropriately with their regulatory body at all times, and a responsible dentist would have sought support if needed. Although the Committee were presented with no evidence of actual patient harm, his failings gave rise to the potential for patient harm. Mr Harateh failed to undertake adequate orthodontic examinations or diagnosis, and failed to keep adequate records. The Committee considers that these failings posed a real risk of potential harm to patients.

The Committee has borne in mind that its primary function is not only to protect patients but also to take account of the wider public interest, which includes maintaining confidence in the dental profession and the GDC as a regulator, and upholding proper standards and behaviour.

Dental professionals occupy a position of privilege and trust in society and must make sure that their conduct at all times justifies both their patients’ and the public’s trust in the profession. In this regard the Committee considered the judgment of Mrs Justice Cox in the case of Grant, in particular the public interest and its duty to protect patients, maintain public confidence in the dental profession, uphold the reputation of the dental profession and declare and uphold appropriate standards of conduct and competence among dental professionals. Given the wide ranging and serious nature of Mr Harateh’s clinical and attitudinal failings which put patients at unwarranted risk of harm, breached a number of standards of the profession and brought it into disrepute, including acting dishonestly, the Committee concluded that public confidence in the profession and in the GDC as a regulator would be undermined if a finding of impairment was not made in the circumstances of this case.

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

Disposal

The Committee next considered what action, if any, to take in relation to Mr Harateh’s registration. It reminded itself that the purpose of a sanction was not to be punitive although it may have that effect. The Committee bore in mind the principle of proportionality.

The Committee considered that to conclude this case with no further action would be wholly inappropriate, insufficient and disproportionate due to the serious and broad range of clinical and attitudinal failings, including dishonest conduct.

The Committee considered the available sanctions in ascending order starting with the least serious. A reprimand would not be an appropriate disposal in the absence of remediation, remorse or insight. The Committee had a grave concern of a real risk of repetition of failings if not remedied.

The Committee then considered whether a conditions of practice order may be imposed on the Registrant’s registration. It noted Mr Harateh’s non-engagement with these proceedings and to date has not been provided with evidence of his current residence. In these circumstances, this Committee could not be confident that Mr Harateh would engage and


comply with any conditions imposed on his registration. A registrant would need to be fully participating in the regulatory process for conditions to have any substantive effect. Further, it is difficult to comprehend what conditions would sufficiently assist Mr Harateh to develop his insight, and reflect upon his attitude towards the responsibilities incumbent upon him as a dentist.

The Committee therefore determined that conditions would neither be workable nor appropriate. In addition, it was of the view that conditions could not address the serious attitudinal failings found proved against Mr Harateh.

In considering whether a suspension would be an appropriate order to impose, the Committee took account of the PCC Guidance:

“The issue of informed or valid consent is a cornerstone of the public interest and must be paramount in a Registrant’s mind prior to carrying out any treatment or investigation… A dental practitioner must not undertake work that is outside their scope of practice… Every patient is vulnerable when receiving treatment and therefore relies on the trustworthiness of the dental practitioner, which they are entitled to expect based on the practitioner’s registered status… Patients, employers, colleagues and the public should be able to rely on a dental professional’s integrity… Dishonesty, particularly when associated with professional practice, is highly damaging to the dental professional’s fitness to practise and to public confidence in the profession.”

The Committee concluded that its findings demonstrated evidence of professional attitudinal problems by the Registrant and behaviour which was fundamentally incompatible with being a dental professional. The Committee is satisfied that Mr Hareteh has breached the fundamental tenets of the profession and has brought the profession into disrepute. This was serious dishonesty and a failure to obtain indemnity insurance against the background where Mr Harateh had disengaged with his regulatory body in the conduct of these proceedings. There was no evidence of the Mr Harateh’s insight into the seriousness of his actions and the consequences.

The Committee considered that in the light of this a period of suspension could not be relied upon to resolve these issues and would not adequately reflect the serious nature of the failings, in particular the dishonesty which was targeted against Mr Harateh’s patients.

The Committee determined that the appropriate and proportionate order to make was one of erasure. It has therefore directed that Mr Harateh’s name be erased from the Dentists Register pursuant to Section 27B (6)(a) of the Dentists Act 1984, as amended.”

________________________________________________________________________

“Decision on immediate order of suspension

The Committee took account of the submissions made by Ms Bates on behalf of the GDC that an immediate order should be imposed on Mr Harateh’s registration. The Committee accepted the advice of the Legal Adviser.

The Committee noted that in the event of an appeal of this Committee’s decision, there was a risk that Mr Harateh’s registration could be unrestricted. In the light of the Committee’s concerns about the Registrant’s lack of insight, remorse, remediation and the need to protect patients and the need to maintain public confidence in the profession and the GDC as a


regulator, the Committee determined, pursuant to Section 30 of the Dentists Act 1984, as amended, that an immediate order is otherwise in the public interest.

The effect of the foregoing direction and this order is that Mr Harateh’s registration will be suspended with immediate effect and unless he exercises his right to appeal, the substantive direction of erasure will take effect 28 days from when notice is deemed served on him. Should he exercise his right to appeal, this order for immediate suspension will remain in place pending the resolution of any appeal proceedings.

That concludes the case for today.”

HEARING HEARD IN PUBLIC HARATEH, Bashar Registration No ...

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