A dentist who failed to spot that a patient was suffering with mouth cancer has been allowed to continue to practice.
The General Dental Council (GDC) decided on the fate of Nalin Dhamecha earlier this month as he faced allegations relating to his failures in 2006 when treating a patient with a lesion on his tongue.
The patient – Robin Read, 44 – subsequently died on 29 July 2007 following a diagnosis of a squamous cell carcinoma of the tongue.
Nalin Dhamecha diagnosed the ulceration on the patient’s tongue as denture trauma on 5 May 2006, but failed to record his current smoking status.
Over the course of four visits by the patient on 5 and 15 May and 16 and 20 October, Mr Dhamecha did not record the status of the ulcer and that it had not healed, nor was any referral made to a specialist.
The Committee accepted that when carrying out the extra-oral examination, he examined the lymph nodes and noted nothing abnormal.
The Committee also judged that it was not unreasonable for the ulceration to have been attributed to the patient’s defective partial upper denture.
Mr Dhamecha noted on the patient’s second visit on 15 May that there had been a degree of
healing of the ulcer which was attributed to the patient not wearing his denture, thus giving an
opportunity for the ulcer to improve.
Mr Dhamecha was aware of an ulcer on the patient’s tongue by 15 and 20 October, when the
patient attended the surgery in connection with his new denture.
The Committee stated that it would have expected him to carry out a careful examination of the patient’s mouth.
It was thought probable that such an examination would have revealed the presence of a further lesion of the tongue.
The Committee concluded that these were serious omissions that – whilst not causing or contributing to the patient’s death – impacted on and breached the duty of the profession to protect patients from harm.
They were persuaded that they were sufficiently serious to constitute misconduct.
The Committee stated that it gave considerable weight to the public protection element of this case when considering the test for impairment and fitness to practice because the lesion on the patient’s tongue would have been detected if Mr Dhamecha had treated the patient appropriately on either 16 or 20 October 2006.
The GDC panel members ruled that it was ‘not unreasonable’ for Dhamecha to assume the ulcer had been caused by a faulty denture after the two initial appointments in May, and accepted that he had examined Mr Read’s lymph nodes.
But they found that his failure to realise it had not healed, or to make an urgent referral to a specialist on re-examination on October 16 and 20 amounted to misconduct.
Dhamecha was told: ‘The committee feels that in regard to sanctions, it is entitled to give significant weight to your excellent practice both before and after 2006, the fact that the GDC accepts that you pose no risk to patients, that you are a dedicated and valuable member of the dental profession and your community, and the fact that you are, by your own admission, devastated by your failure.’
However, he also told Dhamecha: ‘You failed to observe what was a significant lesion in Mr Read’s tongue.
‘These were serious omissions which, whilst not causing or contributing to his death, impacted on and breached the duty of the profession to protect patients from harm.’
Dhamecha will now be able to continue in practice, as long as he attends a minimum of 10 hours of courses on identifying potentially malignant lesions.
He will also be required to keep a logbook on the management of patients with oral problems such as lesions for the next 12 months.
Conditions were imposed on his practice requiring him to attend a verifiable continuing professional development course on the subject of the recognition and management of oral mucosal disorders, with particular reference to potentially malignant and malignant lesions and to keep a reflective log diary concerning the presentation and management of a selection of patients with oral mucosal disorders seen in practice and a hospital setting.