Dentist whose patient died hours after he removed 10 teeth is struck off

A dentist has been struck off after one of his patients died hours after he pulled out 10 of her teeth.

The woman, who is known as 'patient A' told Tushar Patel she was taking blood-thinning medicine Warfarin but a conduct hearing was told he ignored guidance "well-known to dentists".

She collapsed at home "bleeding from her mouth" and bled to death after being rushed to hospital.

The General Dental Council (GDC) hearing was told the woman, who suffered from a rare blood condition that causes clotting, had advanced gum disease and experienced dentist Patel removed all of her top teeth during two appointments, within a week.

The GDC was informed and a hearing professional conduct hearing last week ruled his fitness to practice was impaired.

The GDC panel heard Patel failed to discuss with her the complex needs and increased risk of bleeding because she was taking Warfarin.

It ruled he failed to "weigh up the risks" of his treatment and ignored guidance "well-known to dentists".

He didn't carry out checks in line with industry-standard guidelines to assess the patient's risk of post-operative bleeding, or dress her wounds properly.

The report, published on Tuesday, said: "The committee has found […] you failed to adequately discuss or adequately record any discussions, with Patient A regarding her complex medical history.

"This was in spite of the fact Patient A had provided you with a full medical history questionnaire […] before you embarked on any treatment.

"You failed to pack or suture the extraction sockets.

"You also failed to provide Patient A with specific post-operative instructions relevant to her increased risks.

"Your failures placed Patient A at a significant and avoidable risk of harm and were in contrary to guidance.

"These were basic errors which placed Patient A at significant risk of harm, when this could have, and should have been avoided.

"This amounted to a repeated disregard for patient safety which can be described as serious.

"The committee has determined that your fitness to practice is currently impaired by reason of your misconduct.

"You failed to provide an acceptable standard of care for Patient A […] the committee has determined that your registration be suspended for the maximum period, 12 months."

Documents from the GDC said Patel first examined Patient A in May 2013 when he diagnosed her with advanced periodontal disease – also known as gum disease.

He said she needed some teeth out and extractions were planned for her next appointment – but she didn't come in for another four years.

The patient came back June 5 2017, complaining of her "teeth falling out".

She told him she was taking Warfarin to treat a condition called thrombotic thrombocytopenic purpura, which causes blood clotting.

The GDC heard how Mr Patel did not carry out checks in line with industry-standard guidelines to assess the patient's risk of post-operative bleeding.

Mr Patel extracted five of the patient's teeth on July 13 and five teeth on July 18.

He however failed to discuss or record discussions, about her bleeding history and failed to advise her of the increased risk of bleeding following the extractions, the panel heard.

According to the GDC's report, Warfarin has been widely used for more than 50 years and the risk of postoperative bleeding complications is of concern to dentists.

After having the final five teeth removed by Mr Patel in June 2017, the patient experienced extensive bleeding from the extraction sites, the report said.

Her wounds were not packed or sutured following the treatment, on July 13 or July 18 it added.

The patient attended A&E at King's College Hospital in London, on July 18, but was discharged following treatment to attempt to stop the bleeding.

But after collapsing at home during the early hours of July 19 she was taken to King's College Hospital by ambulance but medics were unable to save her life, and she was pronounced dead at 9.26am on July 19.

On March 21 2018 a coroner ruled the medical cause of death was haemorrhage from the tooth extraction site and Warfarin treatment and dental extraction.

A registered dentist provided evidence at the GDC hearing to give opinion on whether Mr Patel's conduct fell short during the patient's treatment.

The dentist, Ms Glass, said Mr Patel should have paced and/or sutured the wounds and should have "taken steps to manage Patient A's risk of bleeding".

Mr Patel accepted "the most serious consequences of your actions" and admitted the allegations put to him, the report said.

The GDC charged Mr Patel and found a total of eight charges relating to his treatment of Patient A.

The panel found all of the charged were proved.

They relate to his treatment of the patient and how he failed to properly consider her medical history and increased risk of bleeding.

The panel found him impaired to work, the report said.

It added: "The committee takes a serious view of the findings against you.

"There were multiple errors and a failure to follow the appropriate guidance.

"These were basic errors which placed the patient at significant risk of harm.

"This was not a single error, but a catalogue of errors.

"Patient A was a vulnerable patient and you failed to recognise this situation.

"Public confidence would be undermined if a finding of impairment were not made.

"The committee has determined that your fitness to practice is currently impaired by reason of your misconduct."

A GDC hearing report ruled Mr Patel breached clinical care and decided his behaviour is "fundamentally incompatible with remaining on the register".

Mr Patel's registration to practice was suspended for the maximum period available to the panel – 12 months.

He has expressed remorse and has apologised to the patient's family, the GDC report said.

Pending an appeal by Mr Patel, the suspension will start on November 11, 2019.

Mr Patel graduated from Sheffield University in 1986 with a degree in dental surgery and was a dentist at Confidential Clinics in Purley, Surrey.

He has no previous fitness to practice history.

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