Dentist had 'total disregard' for his patients

A Greymouth dentist who overcharged patients and did work that was not needed, has had his registration cancelled and has to pay $160,000, after being found guilty of professional misconduct.

Dr Bharath Subramani has also been censured by the Health Practitioner's Disciplinary Tribunal, which heard charges arising from his treatment of 11 patients on the West Coast.

In a decision released today, the tribunal found Dr Subramani had a "total disregard" for the well-being of his patients in providing and charging for treatment that was not necessary.

The charges relate to his work for a Greymouth Lumino dental surgery, and pre-date the opening of his own dental practice.

Dr Subramani, originally from India, also did implants that he knew — or ought to have known — he was not competent to perform.

"He knows what is required when he is under supervision, but once there is no oversight, he ignores the standards expected of a reasonable dentist," the tribunal said.

The tribunal sat in Greymouth in February last year to hear a charge laid by a professional conduct committee of the Dental Council of New Zealand.

Dr Subramani began working at Lumino Garry Rae Dentists in Greymouth in mid-2014. Lumino opened a further dental practice in Greymouth, Lumino Greymouth Dental Care, and from October 2017 Dr Subramani was the sole dentist in charge there until October 2018, which is where the charges stem from.

In September 2018, Lumino terminated Dr Subramani's contract.

Since early 2019, he has had his own practice, Coast Smiles Dental Spa, where he practises under supervision.

Dr Garry Rae said once supervision was completed in July 2016, and Dr Subramani had achieved his recertification, there was a marked change in attitude.

Dr Rae said that Dr Subramani developed a temper, was intimidating and became verbally aggressive with staff, and "threw his weight around".

Lumino clinical adviser Dr Chris Brooks said the revenue Dr Subramani generated was more than double that which he generated when at Lumino Garry Rae.

Dr Subramani told the tribunal he was devastated to be facing the charge, recognised he had several shortcomings, was out of his depth in some treatments and his communication was insufficient.

He also acknowledged that his notes fell well short of what was required.

Dr Subramani said in his culture, in India, they took a much more black and white approach to things and there was not much dialogue in the dentist-patient relationship.

He felt he was treated disparagingly in the clinic and in front of patients. He felt very much in the minority in Greymouth and therefore felt isolated. 

He outlined changes he had made, including showing the patient their own radiographs and explaining more fully exactly what treatment is needed.

He now avoided too much treatment in one sitting.

Supervisor Dr Michael Shand, of Christchurch, told the tribunal that Dr Subramani understood what to do and his clinical decisions were satisfactory, and had demonstrated marked improvement.

But the tribunal found there was physical, financial and emotional harm to patients and Dr Subramani's conduct breached the trust of patients.

"Dr Subramani's behaviour likely undermined the confidence of those patients and of other members of the public dentists, which in turn has the potential to compromise their oral health."

He was not yet able to perform root canals without further education and supervision.

"The tribunal considers Dr Subramani is operating at the level of a junior dental student. The degree of supervision and scope is that of a third or fourth-year student.

"The public is entitled to expect that when they consult a registered dentist, he or she is able to meet the basic standards of the practice of dentistry.

"The difficulty with the current supervision regime is that it is not sustainable. The supervisor is not available indefinitely. Other than that, there appeared to be no clear plan to progress or end goal. The public is entitled to assume that a dentist who has been registered in New Zealand for nearly 10 years does not require the level of supervision of a dental student."

The tribunal formed the view that Dr Subramani says what he thinks it wants to hear. It found negligent care was delivered to 11 patients and some of the conduct was unethical.

Over an 11-month period, multiple fillings were placed when not required.

The failure to record a patient's medical history was a major departure from accepted practice and potentially fatal.

His "overtreatment and overcharging" of two patients who were superannuitants was a significant breach of his obligations and of their trust.

The tribunal ordered: Censure; Cancellation of registration; fine of $10,000; a contribution of 37.5% to the costs incurred amounting to $150,000.

The patients all have name suppression, and the tribunal heard:

  • In one case he took out a tooth without getting adequate x-rays, or doing a proper evaluation. The patient only found out that his teeth had been cleaned when later shown his clinical notes. Four of the five fillings placed by Dr Subramani had fallen out within three to four months.
  • A review of another patient alleged two teeth which got fillings did not appear to have decay or enough decay to warrant fillings.
  • One patient was told by a Hokitika dentist his implanted teeth were not up to the gums properly and he already had infections, and one had been put in crooked. The patient paid Dr Subramani $35,772 up front for the treatment. The Hokitika dentist wrote to the Dental Council articulating his concerns. To remedy it, the patient had his top teeth removed.
  • When one patient was sedated, Dr Subramani failed to exercise reasonable care.
  • After a patient lost teeth in a work accident, he repositioned one that was likely to fail.
  • A woman was told her root canal needed fixed, despite reporting no problems with it. Another dentist found it appeared no diagnostic tests had been done and could find no records stating why the root canal treatment was required. Dr Subramani recommended she get a night splint for grinding. The other dentist could not see any wear on her teeth to even warrant a suggestion to the patient about this being a treatment
  • option.
  • One patient was told it would cost $1600 to fix their plate but got a bill for $2700. More work was done and he was given a bill for an additional $5000. Three of the seven fillings had to be redone a year later. Dr Subramani accepted that he charged excessive fees for this dental work.
  • Dr Subramani recorded in his clinical records that one woman has tobacco stains on her teeth. She does not and has never smoked cigarettes.
  • One woman almost lost a tooth in an accident and a temporary crown was placed. It was grey and she was embarrassed to smile because of it.
  • Another woman only found out Dr Subramani had done fillings after an emergency appointment with Garry Rae. Dr Surbamani's comment "bleeding upon brushing with a foul smell" was completely inaccurate, and she found that offensive. She too was told she needed a mouth guard. -- Staff reporter

 

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