Dentist failed to spot oral cancer, GDC told

A dentist who failed to 'adequately examine or assess a malignant ulcer' of a patient who subsequently died has had conditions imposed on him for one year by the General Dental Council (GDC).
 
It was only after seeking a second opinion that the patient was sent for a biopsy that revealed he had a squamous cell carcinoma.
 
Dr MacFarlane is employed as a senior dental officer (student outreach)/honorary clinical teacher with NHS Ayrshire, and Arran and the University of Glasgow.

The case concerns his treatment of a patient between December 2009 and June 2010, at the Teach and Treat Dental Clinic, Kilmarnock, where he practises – the clinic is part of the adult outreach programme for final year undergraduate dental students.

Patient A attended the clinic on 11 February 2010, when a dental student, under Dr MacFarlane's supervision, identified an area of ulceration around the LR8 crown.
 
This was incorrectly diagnosed as a traumatic ulcer – and Dr MacFarlane failed to give smoking cessation advice to the patient who had identified himself as a smoker.
 
During the course of Patient A’s treatment, Dr MacFarlane failed to:

• Ensure he was invited back for a review should the ulcer persist for more than three weeks
• Adequately examine or assess the malignant ulcer
• Ensure he was urgently referred for a specialist opinion, despite the persistence of the ulcer and its growth between the examinations of 9 March 2010 and 28 April 2010.
 
In May 2010, Patient A, while on holiday in Oxford, decided to obtain a second opinion regarding the ulcer on the right-hand side of his mouth, was examined and the dentist contacted a maxillofacial surgeon who later examined Patient A and undertook a biopsy.
 
This was subsequently relayed back to Dr MacFarlane who then referred Patient A to the Cross House Hospital for further treatment.
 
On 14 June 2010, the biopsy revealed that Patient A had a squamous cell carcinoma. He subsequently carried on with the proposed treatment but later died.
 
Dr MacFarlane was told by the GDC: ''The treatment you provided to Patient A in 2010 represents a serious departure from the standards of dentistry reasonably expected of you. Although this Committee is only concerned with your deficient practise in respect of one patient, your acts and omissions related to three separate occasions spanning several months. You ignored clear relevant guidance.
 
'The committee determined that this falling short from the standards reasonably expected of you and the departures from the guidance amounted to misconduct.'
 
But the committee added: ‘You have expressed remorse and have apologised sincerely to Patient A’s widow for your failures and also for the suffering she subsequently experienced.
 
'You have taken substantial steps to address deficiencies in your practise… You have worked hard to undertake a considerable amount of relevant CPD, intended to remedy the deficiencies identified in your practise.’
 
However, they expressed concerns regarding his  ‘adequately supervising and taking responsibility for the assessments’ carried by his dental students, which includes checking histories, examinations, and note taking, and allowing patients to leave the clinic before such checks had been undertaken.
 
Conditions imposed on Dr MacFarlane included:
• He must allow the GDC to exchange information with his employer, or any contracting body for
• He must work with a nominated deputy, to undertake a significant event analysis to be fed into a learning needs analysis to formulate a Personal Development Plan, specifically designed to address deficiencies in the below mentioned areas of his practise, and any deficiencies identified in the analysis:
·       Smoking cessation advice.
·       Supervision of students in respect of histories and examinations.
·       The review of the patient and their notes prior to the patient leaving the clinic.
·       A system to manage patients with lesions with regards to current guidelines.
• He shall maintain a log detailing every case where he supervises a patient or sees his own patient with a soft tissue lesion
• He must provide a copy of this log to the GDC on a six monthly basis or, alternatively, confirm that there have been no such cases
• He must permit the GDC to disclose the above conditions, (1) to (13), to any person requesting information about his registration status.
 

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