1. Pursuant to section 77 (4)(c) of the Health Professions Registration Act 2005 (Victoria) Dr Abdullah is reprimanded.

At the request of the parties the Tribunal further finds that:

1. It is necessary in the interests of justice to de-identify the name of the notifier and patient in these proceedings.
2. The orders are necessary to avoid causing undue distress to the patient.

The Tribunal orders pursuant to section 17 of the Open Courts Act 2013 that:

1. The disclosure by publication or otherwise of any report of the whole or any part of this proceeding, or of any information derived from this proceeding, which identifies or has the effect of identifying the notifier or any patient in this proceeding is prohibited.
2. These orders apply throughout Australia. The Tribunal's reasons for decisions are published on the AustLII website, which is accessible throughout Australia.
3. This order operates until the death of the notifier and patient or until further order

1. On 6 May 2014, the Dental Board of Australia referred the conduct of Dr Abdullah to this Tribunal relating to her dental treatment of patient PT during the period 2009 to 2010.
2. The hearing proceeded before us on 2 December 2015, at which time the parties placed before us an Agreed Statement of Facts together with joint submissions in relation to proposed findings and determinations.
3. Having considered all of the material contained within the Tribunal book and Tribunal files and having heard the submissions of the parties we were satisfied that the Agreed Statement of Facts accurately chronicled the facts in this matter. We have accordingly incorporated those facts into this decision.

1. Dr Abdullah has been registered as a dentist in Victoria since 2 January 2007.
2. From the time of her initial registration, Dr Abdullah continued to renew her registration with the Dental Practice Board of Victoria ("the DPBV") and more recently the Dental Board of Australia ("the National Board"). At all material times Dr Abdullah's primary place of dental practice was at 1 Berringa Court, Meadow Heights.
3. Dr Abdullah is currently registered as a general dentist with the National Board subject to conditions.
4. On 17 October 2011, a Performance and Professional Standards Panel pursuant to s.191(b)(i) of the National Law found Dr Abdullah had behaved in a way that constituted unsatisfactory professional performance and imposed conditions on her registration. (see Annexure (2)). The 17 October 2011 conditions in Annexure (2) were removed and replaced by the conditions in Annexure (3), under s.178 of the National Law on 10 April 2013, after issues were raised by Dr Abdullah's orthodontic supervisor. (see Annexure (3)).
5. On 10 December 2014, the 10 April 2013 conditions in Annexure (3) were removed from Dr Abdullah's registration and the additional conditions were imposed on Dr Abdullah's registration under s.178(2)(c), after the Board decided that the way Dr Abdullah was practising dentistry was or may be unsatisfactory. These conditions remain on her registration. (see Annexure (1)).

1. The Notice of Allegations, contains allegations relating to the conduct of Dr Abdullah occurring between February 2009 and March 2010, during a period of time before the Health Practitioner Regulation National Law Act 2009 (Vic)(" the National Law") came into effect, and during the period when the Health Professions Registration Act 2006 (Vic)("the HPR") was in force.
2. Formerly, Regulation 30 of the Health Practitioner Regulation National Law ("the Regulations") provided that a prior corresponding Act was relevant to the prior conduct if:

(1)(a) ...The National Agency receives a notification about a registered health practitioner...; and

(1)(b)The subject matter of the notification happened while the practitioner ... was registered in a health profession under a corresponding prior Act.

(2) Proceedings may be taken under Part 8 of the Law in relation to the registered health practitioner's... behaviour while registered under the corresponding prior Act as if the person were registered under the Law by the National Board established for the health profession.

(3) However, subclause (2) applies only to the extent -

(a) A notification about the registered health practitioner's... behaviour could have been made under the corresponding prior Act; and

(b) Proceedings of that type could have been taken under the corresponding prior Act.

1. Regulation 30 was a savings and transitional provision which expired on 30 June 2015. Nevertheless, because the notification about Dr Abdullah's behaviour, the investigation of that behaviour and the decision to refer the matter to the Tribunal was made prior to the expiry of that provision, we accept that the matter continues and may be dealt with as if Regulation 30 had not expired[1].
2. Regulation 30 applies to Dr Abdullah's conduct which occurred prior to 1 July 2010, at which time she was registered under the HPR Act. The HPR Act is a "corresponding prior Act" for the purpose of s.5 of the National Law. There was power to conduct an investigation and hearing under the HPR Act into Dr Abdullah's alleged conduct[2].
3. As a result of Regulation 30(2) and (3), the Board had power to determine to initiate an investigation and to determine to refer the conduct to the Tribunal for a hearing and the Tribunal has the power to hear and deal with the conduct of Dr Abdullah under Part 8 of the National Law. The Tribunal has the power to make findings and determinations that were available at the time of the conduct under the HPR Act.

1. Between February 2009 and March 2010 Dr Abdullah provided dental treatment to PT.
2. The treatment consisted of conducting an examination of PT's dentition; performing root treatment on her 23 tooth; placing a direct post on her 21 tooth and re-cementing an existing bridge between PT's 11 and 22 teeth; preparing a crown for PT's 11, 21 and 23 teeth for a four bridge unit; cementing the bridge; and re-cementing the bridge after it failed and fell out.
3. The allegations the subject of these proceedings allege that Dr Abdullah provided substandard treatment, failed to make and keep adequate patient records, failed to obtain informed consent and breached a condition of her registration. A further allegation of failure to complete treatment was withdrawn by the Board with our approval. We turn then to a consideration of each of the allegations.

1. The particulars were contained in paragraph 10 of the Notice of Allegations as follows:

10.1 Dr Abdullah failed to adequately assess PT before commencing complex treatment:

(a) Dr Abdullah failed to conduct an analysis of periodontal health, vitality of teeth, or an occlusal analysis.

(b) Dr Abdullah failed to take periapical radiographs of PT's teeth 11 or 21.

(c) Dr Abdullah failed to carry out any post completion radiographs of PT's 23 tooth.

10.2 On or around 30 April 2009, Dr Abdullah cemented the four unit bridge on PT's 11, 21, 22 and 23 teeth.

10.3 In or around March 2010, the bridge exhibited signs of failing when it became loose and unstable.

10.4 On or around 13 March 2010, PT's two front teeth (teeth 11 and 21) which were part of the four unit bridge fell out.

10.5 Subsequent to re-cementing by Dr Abdullah, the bridge again became loose and unstable.

10.6 In or around August 2011, PT was advised by her new treating dentist that the bridge placed by Dr Abdullah had failed, requiring the removal of the bridge and the placement of implants to restore PT's front teeth (11 and 21).

1. The Board and Dr Abdullah agreed that we should make a finding under s.77(1)(a) of the HPR Act that Dr Abdullah engaged in professional misconduct within the meaning of paragraph (b) of the definition of that term in section 3 of the HPR, namely:

Conduct that violates or falls short to a substantial degree, the standard of professional conduct observed by members of the profession of good repute or competency.

1. We find that Dr Abdullah's treatment of PT was of an ongoing poor standard. There were cumulative defects and problems which commenced with the inadequacy of Dr Abdullah's assessment of her patient, and continued through the absence of treatment planning and treatment provision. There was a lack of consideration of alternative treatments which would have been pragmatic.
2. Ultimately removal of the bridge and significant remediation was required. In providing substandard treatment to PT, Dr Abdullah breached her obligations to her patient. We do note however, that once the treatment had commenced, Dr Abdullah was placed on a path in her treatment of PT, where in reality she had passed the point of no return and therefore continued.
3. We were satisfied that the conduct amounted to professional misconduct transcending unprofessional conduct. We were so satisfied, given the extent of the failings. However we place the conduct at the lower end of the scale of professional misconduct noting as we do that the conduct only pertains to one patient and course of treatment.

1. The particulars were contained in paragraph 11 of the Notice of Allegations as follows:

11. The particulars include but are not limited to:

11.1 During the PT Treatment, Dr Abdullah failed to document consent obtained for any procedures carried out on PT.

11.2 In or around 24 February 2009, Dr Abdullah failed to document all clinical procedures carried out on PT.

11.3 On or around 15 March 2009, Dr Abdullah failed to document all clinical procedures carried out during the treatment of PT.

11.4 On or around 30 April 2009, Dr Abdullah failed to document the instructions given to PT regarding her occlusion and how to wear her partial denture. Dr Abdullah also failed to record any instructions that she had provided to PT regarding the use of a bridge.

11.5 During the PT Treatment, Dr Abdullah failed to make any record referring to PT wearing dentures.

1. The Board and Dr Abdullah agreed that we should make a finding under s.77(1)(a) of the HPR Act that Dr Abdullah engaged in unprofessional conduct within the meaning of paragraph (b) of the definition of that term in section 3 of the HPR in that her conduct was of a lesser standard than peers would reasonably expect.
2. We accept that this is an appropriate finding. We accept that the records that Dr Abdullah generated in respect of the treatment provided to her patient PT were inadequate in the terms alleged.
3. When the National Board's predecessor, the DPBV, regulated the practice of dentistry in Victoria it developed and published policies, codes and guidelines to provide assistance and support to the profession to deliver appropriate, effective services. The provisions of those codes and guidelines apply equally today under the guidance of the National Board. All registered health practitioners have a professional responsibility to be familiar with and abide by the codes and guidelines. The DPBV always had clear and detailed guidelines on how a patient record should be created and maintained[3].
4. It is necessary to maintain patient records to properly record patients' histories, physical findings, investigations, treatment, and clinical progress. A patient record documents the basis for the clinical management of a patient and reflects the quality of care. It is necessary for continuity of care. The patient record should be systematic, accurate, adequate, clear and contemporaneous. The patient record should document the patient's presenting complaint, relevant history, any clinical findings, diagnosis, treatment plans, reasons for such, alternative treatments available and the fact that informed patient consent has been obtained. Dr Abdullah's records did not adequately do so.

1. The particulars were contained in paragraph 12 of the Notice of Allegations as follows:

12. The particulars include but are not limited to:

12.1 Prior to and/or during the PT Treatment, Dr Abdullah failed to provide PT with an explanation of treatments/options available, the risks associated with the treatments or the likely outcomes, advantages or disadvantages associated with the PT Treatment.

12.2 Prior to and/or during the PT Treatment, Dr Abdullah failed to obtain a signed consent form from PT.

1. The Board and Dr Abdullah agreed that we should make a finding under s.77(1)(a) of the HPR Act that Dr Abdullah engaged in Professional Misconduct within the meaning of paragraph (b) of the definition of that term in section 3 of the HPR. We also agree.
2. We find that the consent that Dr Abdullah obtained from PT, prior to and at the time of providing her with treatment, was insufficiently informed by reason of her failing to provide PT with an adequate explanation of treatment options available to her, the risks associated with the treatments or their likely outcomes, the advantages and disadvantages associated with the treatment. We also note that she failed to obtain a signed consent form from PT.
3. A dental practitioner must help patients make well-informed decisions about their proposed treatment. This responsibility falls within the practitioners overarching duty to take reasonable care in looking after his/her patient.
4. In July 2007, the DPBV published Information Sheet No. I002 [2007] entitled "Consent: Assisting patients to make well-informed decisions". The Code and the Information Sheet was available on the (then) website of the DPBV at www.dentprac.vic.gov.au and it was regularly publicised by the DPBV and often referred to in its regular newsletters. It provided guidance on the level of information and detail patients should be provided with prior to the commencement of treatment. It noted that a practitioner should use words that a patient could understand, allow a patient to ask questions, repeat information when required, allow a patient time to make a decision regarding treatment and refrain from any sort of pressure and where necessary make use of an interpreter.
5. Well-informed decisions can only be made by a patient if the patient has adequate information before treatment is commenced. It is important that a patient is kept abreast of any risks or possible complications and any alternatives to the proposed treatment. Dr Abdullah neither understood nor complied with her obligations and failed her patient in this regard. Once again we accept, given there was only one patient this conduct falls at the lower end of professional misconduct. The finding nevertheless reflects the substantial falling short on this occasion of what is required.

Breach of Agreement made with the Dental Practice Board of Victoria

1. The particulars were contained in paragraph 14 of the Notice of Allegations as follows:

14. The particulars include but are not limited to:

14.1 In or around November 2009, the DPBV imposed a condition on Dr Abdullah's registration requiring her to refrain from practising in crown, bridge and implant work until such time as she had completed further education in these areas to the satisfaction of the Dental Practice Board of Victoria (DPBV).

14.2 This condition was still in place when, in or around March 2010, PT's bridge failed and she attended Dr Abdullah's dental surgery for clinical assistance.

14.3 On 16 March 2010, Dr Abdullah treated PT by re-cementing her four unit bridge.

1. The Board and Dr Abdullah agreed, as do we that we should make a finding under s.77(1)(a) of the HPR Act that Dr Abdullah engaged in Unprofessional Conduct within the meaning of paragraph (b) of the definition of that term in section 3 of the HPR.
2. We find that Dr Abdullah breached a condition on her registration commencing in November 2009 to the effect that she would not practise in the areas of crown, bridge and implant work until such time as she had completed further education in these areas to the satisfaction of the DPBV when in March 2010 she treated PT by re-cementing her four-unit bridge after PT attended Dr Abdullah's practice subsequent to the failure of her bridge.
3. We accept that there were extenuating circumstances in the form of PT's insistence upon being provided with treatment and that ultimately Dr Abdullah provided what she considered to be emergency management in re-cementing the bridge. We accept that this circumstance offers some mitigation to the conduct. Nevertheless Dr Abdullah was required by the conditions imposed on her registration not to undertake the work. She should not have succumbed to the pressure being placed upon her. She should have found the patient another practitioner to assess the situation after assessing what had happened to the bridge or referred the patient to a specialist prosthodontist.

1. The purpose of the imposition of determinations in disciplinary matters is to protect the public and maintain proper ethical and professional standards within the profession. It is not the aim of determinations in disciplinary proceedings to be punitive.
2. The Board and Dr Abdullah agreed that we should reprimand Dr Abdullah for engaging in professional misconduct and unprofessional conduct pursuant to s.77(4)(c) of the HPR. The parties also proposed that we should impose a fine of $3000.
3. We agreed that a reprimand was appropriate in all of the circumstances of this case. We note that for professionals any form of official censure is of consequence. Marks J in Peeke v Medical Board of Victoria[4] observed that a reprimand being a serious form of censure and condemnation does not trivialise a serious lapse of professional standards and has the potential for serious adverse implications for the medical practitioner.
4. We did not however consider it necessary to impose a fine or any further conditions or penalties upon Dr Abdullah.
5. In light of the fact that Dr Abdullah's registration remains subject to the supervisory conditions set out in appendix 1, there is no need to protect the public through the imposition of further conditions. She is already subject to restrictions, monitoring and further education.
6. We considered that the proposed fine would similarly serve no useful purpose given the fact that the conduct the subject of the allegations occurred a number of years ago, and that Dr Abdullah has co-operated with the conditions currently on her registration, which we note have had a significant impact on her financially.

1. Pursuant to section 77 (4)(c) of the Health Professions Registration Act 2005 (Victoria) Dr Abdullah is reprimanded.

(1) Dr Abdullah is not to commence new orthodontic cases until approved to do so by the Board.

(2) Prior to requesting the Board to review condition (1) as stated above, Dr Abdullah is required to complete a Board-approved tertiary level course in Orthodontics and meet the Board's specific requirements in relation to this:

(b) Within 28 days of completing the education Dr Abdullah must provide a report to the Board detailing the following information:

i The objectives met and achieved by attending the education.

ii How she intends to apply the knowledge learned form this education in her future practice of dentistry.

(3) Dr Abdullah may only continue providing orthodontic treatment to her current orthodontic patients under Level 3 Supervision of a Board-approved orthodontist (the orthodontic supervisor) and meet the Board's specific requirements in relation to this:

(a) The orthodontic supervisor is to review and assess each of Dr Abdullah's current orthodontic patient cases.

(b) The orthodontic supervisor is to provide a report to the Board summarising the progress of each orthodontic case and the expected completion date of each orthodontic case.

(4) Dr Abdullah may only continue practising in general dentistry under Level 3 Supervision of a Board-approved dental practitioner (the dental supervisor) and meet the Board's specific requirements in relation to this:

(a) The dental supervisor is required to meet with Dr Abdullah:

ii Then fortnightly for the following three months;

iii Then once per month for the remaining supervision period, or more frequently if so determined by the supervisor.

(b) The meetings are to be for a minimum of three (3) hours and are to be conducted at Dr Abdullah's place of practice.

(c) The dental supervisor must review a minimum of 5 cases at each meeting, which must include all of Dr Abdullah's prosthodontic and implant cases that are currently being undertaken or planned.

(d) If there are not five prosthodontic or implant cases then the dental supervisor may select general dentistry cases for review at random.

(e) The dental supervisor's review of Dr Abdullah's records must consider the following areas of dental practice:

i. Undertaking of full and comprehensive clinical examinations including caries and periodontal risk assessment and periodontal analysis if required;

ii. The taking of medical histories, the impact of general medical conditions, including side-effects of different medications on oral health, and current concepts of use of antimicrobials in dentistry;

iv. Determination of diagnoses and development of a comprehensive treatment plan to address presenting clinical issues;

v. Treatment planning, including the assessment of the occlusion, for all prosthodontic and implant cases;

vi. Preparation of teeth for fixed prosthodontics including impression taking and impression evaluation for crowns and bridges;

viii. The taking of intra-oral radiographs and the interpretation of both intraoral and extraoral radiographs;

ix. The requirements of the various stages of endodontic treatment;

x. The documentation of patient records and informed consent procedures in accordance with the Dental Board of Australia's Dental guidelines on dental records and Code of conduct;

(f) On the 28th day of each month, the dental supervisor is to forward a report to the Board containing, but not limited to, the following information:

i. The date, venue and number of patient records reviewed by the dental supervisor in the most recent month.

ii. Details of any discussions or correspondence had between the dental supervisor and Dr Abdullah in relation to Dr Abdullah's practice of the profession.

iii. Whether or not, in the opinion of the dental supervisor, Dr Abdullah is satisfactorily participating in and complying with the requirements of her supervision.

(5) All costs associated with the education, supervision and provision of reports to the Board are the responsibility of Dr Abdullah.

(6) If the Board considers that Dr Abdullah has failed to comply with the conditions imposed on her registration or has unnecessarily delayed compliance with the conditions, the Board may determine to take further action.

(7) In the event that Dr Abdullah changes her principal place of residence or predominant place of practice to NSW, then the appropriate review body is the relevant NSW Health Professional Council.

(i) Pursuant to section 191(3) of the National Law, Dr Abdullah's new orthodontic treatment plans must all be reviewed, checked (sic) supervised by an AHPRA approved orthodontist;

(ii) Within this reviewing, checking and supervising of all of Dr Abdullah's new orthodontic treatment plans there must be 'face to face' discussion between Dr Abdullah and the AHPRA approved supervising orthodontist;

(iii) This condition will not be considered for removal until:

(a) Dr Abdullah has undertaken 15 reviewed, checked and supervised orthodontic treatment plans for patients; and

(b) Dr Abdullah must provide a satisfactory written professional performance report from the AHPRA approved supervising orthodontist to AHPRA each month and an overall satisfactory professional performance report within 28 days of the completion of this condition.

(iv) Dr Abdullah must undertake this condition at her own expense;

(v) This condition is not to be considered as being in satisfaction of any Continuing Professional Development requirement for the period ending 31 December 2012; and

(vi) Dr Abdullah is to submit to random audits be (sic) AHPRA of her practice to ensure that this condition is being adhered to.

(1) Dr Abdullah will not take on new orthodontic cases until the satisfactory completion of the education stipulated in condition 4 below.

(2) All current orthodontic cases by Dr Abdullah must be reviewed, checked and supervised by an AHPRA approved orthodontic supervisor at stages through treatment as deemed appropriate by the approved supervisor.

(3) Dr Abdullah must supply satisfactory written progress reports from the AHPRA approved orthodontic supervisor at 3, 6, 9 and 12 months.

(4) Dr Abdullah is to complete bimonthly education sessions of no less than one hour with an AHPRA approved orthodontist educator for the next 12 months.

(5) The education must include the following learning objectives:

initial diagnosis and case assessment for orthodontic patients;

understanding best practice methods for treatment of orthodontic patients, ensuring use of study models and photographs to document and assess treatment planning and treatment progress.

(6) Dr Abdullah must supply satisfactory written professional performance reports from the AHPRA approved orthodontic educator at 6 and 12 months.

(7) On completion of the six education sessions with the orthodontic educator, Dr Abdullah must supply a detailed report stating what she has learned from the education and how she has incorporated the learning objectives into her current practice.

(8) All costs associated with the supervision and education will be the responsibility of Dr Abdullah.

[1] Clause 34, Part 6, Schedule 7 of the National law.

[2] see ss.42, 45, 29, 76 and 77 of the HPR Act.

1. [3]In or around July 2007, the then DPBV published the Dental Records Code of Practice No: C003 [2007](Code) together with a Dental Records Information Sheet No: I001 [2007]. The Code and the Information Sheet were available on the website of the DPBV at www.dentprac.vic.gov.au and it was regularly publicised by the DPBV (and later the National Board) and often referred to them in its regular newsletters.

[4] Unreported, Supreme Court of Victoria, No 10170 of 1993, 19 January 1993, at p6