HEARING PARTLY HEARD IN PRIVATE
ROBERTSON, Rita Jane
Registration No: 129239
PROFESSIONAL CONDUCT COMMITTEE
JUNE 2018
Outcome: Facts found proved did not amount to misconduct or deficient
professional performance. Case concluded
CHARGE (as amended on 19 June 2018)
ROBERTSON, Rita Jane, a dental nurse, Verified competency in Dental Nursing, was
summoned to appear before the Professional Conduct Committee on 18 June 2018 for an
inquiry into the following charge:
“That being a practising dental nurse:
1.
Between a date unknown and on or around 20 June 2016 you inappropriately treated
one or more HIV positive patients without wearing gloves.
2.
Between on or around 20 June 2016 and on or around 30 June 2016 you failed to
demonstrate adequate knowledge of cross infection control procedures, including by:
a)
Handling a denture that had been in a patient's mouth without gloves;
b)
Handling a cotton wool roll without gloves;
c)
Handling clean instruments stored in a drawer with gloves that had been in
contact with either a patient or dirty instruments, on one or more occasions;
d)
Removing the protective packet from a bite-wing radiograph plate without
wearing gloves;
e)
Attempting to remove gloves from a glove container with unwashed hands.
AND, by reason of the facts stated, your fitness to practise is impaired by reason of your
misconduct and/or deficient professional performance.”
On 20 June 2018 the Chairman made the following statement regarding the finding of facts:
“Ms Robertson is not present at this hearing of the Professional Conduct Committee (PCC)
and is not represented in her absence. Mr Guy Micklewright of Blake Morgan solicitors
appears for the General Dental Council (GDC).
Proceeding in absence
The Committee determined on 18 June 2018 to adjourn its consideration of whether or not to
proceed with the hearing in Ms Robertson’s absence until 0930 hours on 19 June 2018. That
decision is set out in a separate determination dated 18 June 2018. The Committee directed
those acting for the GDC in this matter to contact Ms Robertson by email, and to follow-up
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by telephone, putting to her a number of questions in relation to her availability and her
intentions.
The Committee also directed that a copy of its determination on adjournment should also be
sent by those acting for the GDC by email to Ms Robertson, and the Committee considered
that it was in Ms Robertson’s own interests that she make herself available for a telephone
call at 0930 hours on 19 June 2018 with the Legal Adviser in the presence of Mr
Micklewright and the Committee Secretary so that her answers to these questions and her
future involvement in this case might be resolved.
The hearing was then adjourned until 0930 hours on 19 June 2018.
On the morning of 19 June 2018 the Legal Adviser spoke with Ms Robertson in the presence
of Mr Micklewright and the Committee Secretary. Upon the resumption of the hearing the
Committee was informed that Ms Robertson had stated that she had previously been told
that she could participate in the hearing via Skype or telephone, and that she had decided
not to do so. She stated that she was content for the hearing to proceed in her absence,
despite being informed by the Legal Adviser that not participating might be detrimental to her
interests. She stated that she wished for the Committee to hear this case this week in her
absence, and that she did not want to seek an adjournment to later dates.
After hearing the submissions of Mr Micklewright and the advice of the Legal Adviser, the
Committee then retired into camera to resume its deliberations on the question of whether to
proceed in Ms Robertson’s absence. After careful consideration the Committee determined
that it was fair and in the interests of justice to proceed with the hearing in the absence of Ms
Robertson. The Committee considered that Ms Robertson had waived her right to attend and
that she had elected not to participate on an informed basis. The hearing then proceeded in
the absence of Ms Robertson.
Preliminary matters
Mr Micklewright applied to amend head of charge 2 (c) in accordance with Rule 18 of the
General Dental Council (Fitness to Practise) Rules 2006 (‘the Rules’) to correct a
typographical error. The Committee accepted the advice of the Legal Adviser, and was
content to accede to the application on the basis that to do so would be fair and in the
interests of justice, and would not be detrimental to Ms Robertson.
Mr Micklewright also applied to have the evidence of the majority of the witnesses in this
case to be heard by Skype to avoid the necessity of travel from Scotland. The Committee
accepted the advice of the Legal Adviser, and considered that it was fair and appropriate for
such evidence to be heard by Skype. In reaching this decision the Committee noted that Ms
Robertson had previously been informed of the Council’s intention to admit such evidence by
Skype and had not expressed any objection.
Background to the case and summary of allegations
The allegations giving rise to this case relate to concerns about Ms Robertson’s cross-
infection and hygiene practises whilst working as a dental nurse.
Ms Robertson worked as a dental nurse for many years at Pitlochry Dental Surgery in
Pitlochry, Perthshire, until some time before June 2016 when the practice closed on the
retirement of the sole dentist. Ms Robertson subsequently applied for and obtained
employment at the nearby Infinityblu Dental Care in Pitlochry. She commenced work there
on 20 June 2016.
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The Council alleges that, during the course of her short employment at that practice from 20
June 2016 to 30 June 2016, Ms Robertson failed to demonstrate adequate knowledge of
cross-infection control procedures. It is specifically alleged that Ms Robertson handled a
denture that had been in a patient’s mouth whilst not wearing gloves, that she handled a
cotton wool roll without wearing gloves, that on one or more occasions Ms Robertson
handled clean instruments stored in a drawer whilst wearing gloves that had been in contact
with either a patient or dirty instruments, that she removed the protective packet from a
bitewing radiograph plate without wearing gloves, and that she attempted to remove gloves
from a glove container with unwashed hands. It is further alleged that she told a dentist at
Infinityblu Dental Care that, whilst working at her previous practice, she had treated three
human immunodeficiency virus (HIV) positive patients whilst not wearing gloves.
Evidence
The Committee heard oral evidence via Skype from an associate dentist at Infinityblu Dental
Care in Pitlochry, who is referred to for the purposes of this determination as Witness 1; from
two dental nurses at Infinityblu Dental Care, who are referred to as Witness 2 and Witness 3
respectively; and from the Practice Manager of Infinityblu Dental Care, who is referred to as
Witness 4. The Committee also heard oral evidence from the expert witness instructed by
the Council, namely Mr Martin Fulford.
The Committee has been provided with documentary material in relation to the allegations
that Ms Robertson faces, including the witness statements and documentary exhibits of the
witnesses referred to above, the expert report of Mr Fulford, and Ms Robertson’s responses
to the allegations.
Committee’s findings of fact
The Committee has taken into account all the evidence presented to it. The Committee has
considered the submissions made by Mr Micklewright on behalf of the GDC and the written
submissions provided by Ms Robertson.
The Committee has accepted the advice of the Legal Adviser. The Committee is mindful that
the burden of proof lies with the GDC, and has considered the heads of charge against the
civil standard of proof, that is to say, the balance of probabilities. The Committee has
considered each head of charge separately.
The Committee was assisted by the oral evidence of Witness 1, Witness 2, Witness 3 and
Witness 4. The Committee found these witnesses to be credible and generally reliable, and
that they did their best to recall the events that have precipitated the heads of charge that Ms
Robertson faces. The Committee was further assisted by the expert evidence of Mr Fulford.
I will now announce the Committee’s findings in relation to each head of charge:
1.
Not proved
The Committee finds the facts alleged at head of charge 1 not proved. The
Committee has been provided with evidence from Witness 1, who states that she
had a conversation with Ms Robertson on a date unknown during which Ms
Robertson told her that at her previous place of work she, and the dentist with
whom she was working at the time, did not wear gloves when in contact with
three HIV positive patients. In her written responses to the allegation Ms
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Robertson denied that she had had any such conversation with Witness 1.
The Committee finds that the GDC has not adduced sufficient evidence to prove
that, on the balance of probabilities, Ms Robertson treated one or more HIV
positive patients whilst not wearing gloves. The Committee has no reason to
doubt that Witness 1, when making her witness statements, was doing her best
to recount the conversation that she had with Ms Robertson. However, while it
considers it more likely than not that there was some discussion about Ms
Robertson’s ‘contact’ with HIV positive patients at her previous practice, it cannot
be satisfied on this evidence that Ms Robertson inappropriately treated one or
more patients whilst not wearing gloves. It noted that Witness 1’s account in her
witness statement was not fully consistent with her earlier undated written note,
in which she referred to gloves not being worn routinely as opposed to at all.
Further, Witness 1 did not question Ms Robertson about this issue, and there is
no detail available about what was said by Ms Robertson during that
conversation about the nature or circumstances of her contact with the patients.
Moreover, the Committee notes from the initial report compiled by Witness 1 that
the primary concerns related to treatment by the dentist as opposed to any by Ms
Robertson.
The Committee notes from the evidence of the other witnesses, and in particular
Witness 3, that Ms Robertson stated that she did not perform much clinical work
at her previous practice, being more concerned with reception and administrative
duties. The Committee notes in particular that there is no evidence as to what
treatment, if any, Ms Robertson was involved in providing to the unidentified
patients in question. The Committee accepts the expert evidence of Mr Fulford
that those practitioners involved in treating patients, whether the patients are HIV
positive or not, must wear gloves when treating them. There is no suggestion that
gloves should be worn at other times.
Given the lack of evidence as to what Ms Robertson was doing, and when, in
relation to the one or more patients, and the lack of clarity as to when she was
wearing gloves and when she was not, the Committee was not persuaded that
the GDC had discharged the burden of proof to the required standard.
Accordingly, it finds the facts alleged at head of charge 1 not proved.
2. (a)
Proved
The Committee finds the facts alleged at head of charge 2 (a) proved. The
Committee finds that it is able to rely on the evidence of Witness 1, who in her
evidence to the Committee stated that she witnessed Ms Robertson handling a
denture that had been in a patient’s mouth whilst not wearing gloves. Ms
Robertson in her written response was not able to specifically recall the incident
in question. The Committee further accepts the expert evidence of Mr Fulford,
who stated that Ms Robertson should not have handled the denture whilst not
wearing gloves. The Committee considers that this amounts to a failure on the
part of Ms Robertson to demonstrate adequate knowledge of cross-infection
control procedures, and accordingly it finds the facts alleged at head of charge 2
(a) proved.
2. (b)
Proved
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The Committee finds the facts alleged at head of charge 2 (b) proved. The
Committee relies on the evidence of Witness 1, who in her evidence to the
Committee stated that she witnessed Ms Robertson handling a cotton wool roll
whilst not wearing gloves. The Committee finds this to be a clear and credible
account, particularly given that Witness 1 was making a specific point of
observing Ms Robertson’s practice in light of her emerging concerns about Ms
Robertson’s adherence to appropriate cross-infection procedures. Ms Robertson
in her written response was not able to specifically recall the incident in question.
The Committee further accepts the expert evidence of Mr Fulford, who stated
that Ms Robertson should not have handled the cotton wool roll whilst not
wearing gloves because of the risks of contamination. The Committee considers
that this amounts to a failure on the part of Ms Robertson to demonstrate
adequate knowledge of cross-infection control procedures, and accordingly it
finds the facts alleged at head of charge 2 (b) proved.
2. (c)
Proved
The Committee finds the facts alleged at head of charge 2 (c) proved. The
Committee relies on the evidence of Witness 1, who in her evidence to the
Committee stated that she witnessed Ms Robertson approaching a drawer which
contained clean instruments whilst wearing gloves that had been in contact with
a patient or with dirty instruments. Witness 1 was not able to recall whether this
occurred on more than one occasion. The Committee finds that, although Ms
Robertson was stopped from handling the instruments after Witness 1’s
intervention, the wording of head of charge 2 (c) is sufficiently broad to include
Ms Robertson’s conduct in attempting to handle the instruments. The Committee
again finds Witness 1’s account to be reliable for the reasons referred to at head
of charge 2 (b) above. The Committee again accepts the expert evidence of Mr
Fulford, who stated that it is important that clean instruments are not
contaminated in this way. The Committee considers that this amounts to a failure
on the part of Ms Robertson to demonstrate adequate knowledge of cross-
infection control procedures, and accordingly it finds the facts alleged at head of
charge 2 (c) proved.
2. (d)
Proved
The Committee finds the facts alleged at head of charge 2 (d) proved. The
Committee relies on the clear evidence of Witness 3, who in her evidence to the
Committee stated that she witnessed Ms Robertson remove the protective
packet from a bitewing radiograph plate whilst not wearing gloves. In her written
response Ms Robertson implied that it was possible that such an incident had
occurred. The Committee further accepts the expert evidence of Mr Fulford, who
stated that Ms Robertson should not have acted in this way because of the
potentially highly contaminated status of the protective packet. The Committee
considers that this amounts to a failure on the part of Ms Robertson to
demonstrate adequate knowledge of cross-infection control procedures, and
accordingly it finds the facts alleged at head of charge 2 (d) proved.
2. (e)
Proved
The Committee finds the facts alleged at head of charge 2 (e) proved. The
Committee relies on the evidence of Witness 3, who in her evidence to the
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Committee stated that, during the course of the same incident dealt with at head
of charge 2 (d) above, she then witnessed Ms Robertson attempting to remove a
pair of gloves from the glove container with unwashed hands. The Committee
again accepts the expert evidence of Mr Fulford, who stated that Ms Robertson
should have sought to avoid contaminating the glove container. The Committee
considers that this amounts to a failure on the part of Ms Robertson to
demonstrate adequate knowledge of cross-infection control procedures, and
accordingly it finds the facts alleged at head of charge 2 (e) proved.
In his closing submissions to the Committee Mr Micklewright contended that the evidence
showed that Ms Robertson did not possess adequate knowledge of cross infection control
procedures. He invited the Committee to consider and to determine whether or not she did
lack such knowledge. The Committee considered that it was appropriate to do this because
this was the underlying criticism of Ms Robertson in this case. In reaching its findings at
heads of charge 2 (a), 2 (b), 2 (c), 2 (d) and 2 (e) above, namely that Ms Robertson failed to
demonstrate adequate knowledge of cross-infection control procedures in each of the
alleged respects, the Committee does not infer that these failings mean that Ms Robertson
necessarily lacked adequate knowledge of those procedures. The Committee did not
consider there to be sufficient examples of Ms Robertson’s failures which might reveal that
she lacked adequate knowledge. It is the Committee’s view that there are a number of
possible explanations for Ms Robertson’s failures. The Committee did not consider that the
GDC had established that the most likely explanation for Ms Robertson’s failings was that
she lacked adequate knowledge of cross-infection control procedures.
We move to stage two.”
On 21 June 2018 the Chairman announced the determination as follows:
“
Proceedings at stage two
The Committee has considered all the evidence presented to it, both written and oral. The
Committee has taken into account the submissions made by Mr Micklewright on behalf of
the General Dental Council (GDC). The Committee has accepted the advice of the Legal
Adviser, and has paid careful regard to the GDC’s
Guidance for the Practice Committees
including Indicative Sanctions Guidance (October 2016).
Fitness to practise history
Mr Micklewright addressed the Committee in accordance with Rule 20 (1) (a) of the General
Dental Council (Fitness to Practise) Rules 2006 (‘the Rules’). He informed the Committee
that Ms Robertson has no fitness to practise history with the GDC.
Application to hear part of the case in private
Mr Micklewright applied for part of the hearing to take place in private in accordance with
Rule 53 (2) of the Rules. Mr Micklewright submitted that he wished to refer to matters
relating to Ms Robertson’s health and private life, and that it would be appropriate for that
part of the hearing to be conducted in private.
The Committee, having accepted the advice of the Legal Adviser, considered that it would
be appropriate for such matters to be heard in private.
Deficient professional performance
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The Committee first considered whether the facts that it has found proved constitute
deficient professional performance. In considering this matter, the Committee has exercised
its own independent judgement.
Having given careful consideration to the matter the Committee determined that those facts
do not amount to deficient professional performance. The Committee considers that the
failings that it has identified have not been derived from a fair sample of Ms Robertson’s
practice. The Committee notes that Ms Robertson was employed at Infinityblu Dental Care
for a ten-day period in June 2016 and worked seven days at the practice during the course
of that short period of employment. The Committee has heard from the witnesses who
worked with her that Ms Robertson exhibited signs of being nervous and it accepts that, as
she was very new to the practice, she was likely to be unfamiliar with the workings of the
particular surgeries in which she was placed.
The Committee notes that the facts that it has found proved relate to a small number of
clinical sessions which took place in a short period of time. Moreover, the findings that it has
made at heads of charge 2 (d) and 2 (e) relate to the same incident in the same clinical
session, and that as Ms Robertson does not appear to have previously used digital-based
radiographic equipment it is reasonable to assume that she was not familiar with the proper
procedures to be followed. The Committee also notes that in that same session Ms
Robertson was shadowing, and was being shadowed by, Witness 3. The Committee also
notes that, in relation to its findings at the other heads of charge, namely heads of charge 2
(a), 2 (b) and 2 (c), Ms Robertson was being carefully monitored by Witness 1 in light of
concerns that she had about Ms Robertson’s practice. Such arrangements, whilst perfectly
proper, can often be stressful and the Committee is not content to conclude that the failings
identified in relation to that session are representative of Ms Robertson’s practice.
The Committee considers that the evidence presented to it is not sufficient to demonstrate
that the failings that it has identified reveal a pattern of poor practice or that those failings are
reflective of Ms Robertson’s work as a dental care professional. The Committee finds that
Ms Robertson’s performance has not been shown to be unacceptably low by reference to a
fair sample of her work and, in the absence of exceptional circumstances, it therefore
concludes that the facts that it has found proved do not amount to deficient professional
performance.
Misconduct
The Committee next considered whether the facts that it has found proved constitute
misconduct. In considering this matter, the Committee has again exercised its own
independent judgement.
Mr Micklewright invited the Committee have regard to the following paragraph of the GDC’s
Standards for the Dental Team (September 2013) in place at the time of the incidents that
have given rise to the facts that the Committee has found proved. The paragraph in question
states that as a dental care professional:
1.5
You must treat patients in a hygienic and safe environment.
After having given the matter careful consideration, the Committee has determined that the
facts that it has found proved do not amount to misconduct. The Committee notes the view
of the GDC’s expert witness, namely Mr Fulford, that each of the failings which the
Committee has since found proved, with the possible exception of the facts at head of
charge 2 (b), relate to acts and omissions which fell far below the standards reasonably to
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be expected of a registered dental nurse. The Committee has found that Ms Robertson did
not demonstrate adequate knowledge of cross-infection control procedures in relation to five
incidents which concern her omission of gloves, and has made findings of her culpable
failings in that regard. The Committee is mindful of the importance of adhering to proper
cross-infection control protocols and principles, and is alive to the risks that can arise when
such standards are not maintained. Ms Robertson’s proven conduct was not acceptable, and
she departed from the cross-infection control procedures that were in place at her new place
of work. However, in assessing whether the failings that it has identified amount to
misconduct, the Committee has been careful to place these individual failings in their proper
context.
As set out above, Ms Robertson was employed at Infinityblu Dental Care for a brief period of
time in June 2016. She commenced her employment on 20 June 2016, and left some ten
days later on 30 June 2016. She worked on seven days at the practice between those dates,
having previously worked at another practice for a considerable number of years. The
Committee is mindful of the difficulties and changes that can often arise when a dental
professional, or indeed any employee, moves from one place of work to another, particularly
when they have been employed at their place of work for quite some time. More particularly,
the Committee considers that it can sometimes take time to adjust to new surroundings and
different ways of working, and a period of acclimatisation, familiarisation and adaptation is to
be expected. The Committee considers that, whilst Ms Robertson’s conduct relates to
culpable failings in demonstrating adequate knowledge of cross-infection control procedures,
those failings can only properly be seen as isolated errors occurring in a specific set of
circumstances. The Committee has been provided with consistent evidence of Ms Robertson
appearing to be flustered, and having sweaty hands. The Committee accepts that it can be
more difficult to place gloves on one’s hands in such circumstances. The Committee has
also heard evidence of Ms Robertson shadowing, or being shadowed by, another dental
nurse at the time of the incidents giving rise to its findings at heads of charge 2 (d) and 2 (e).
A perception of additional pressure can also impact on one’s ability to work at an appropriate
and consistent standard. In such heightened and pressurised circumstances one mistake
can lead to another, as appears to have been the case in relation to the failings identified at
those heads of charge.
Having set the failings that it has identified in their proper and appropriate context, the
Committee considers that, although in each case they fell below the standard expected of a
dental nurse, they did not fall far below such a standard, and to that extent the Committee
did not accept the views of Mr Fulford for the reasons set out above. The Committee
considers that the failings do not suggest that patients were placed at serious risk of harm,
or that the facts that it has found proved would be viewed by fellow dental professionals to
be deplorable. The Committee considers that the failings that it identified are not such
serious departures from the standards reasonably to be expected of a dental care
professional that, when viewed either individually or collectively, they amount to misconduct.
For the reasons set out above, the Committee has determined that the facts that it has found
proved do not amount to misconduct.
Existing interim order
In accordance with Rule 21 (3) of the Rules and section 36P (10) of the Dentists Act 1984
(as amended) the interim order of suspension in place on Ms Robertson’s registration is
hereby revoked.
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That concludes this case.”
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