AC-2025-LON-000160 - [2025] EWHC 3006 (Admin)

As I have noted at the outset of this judgment, the PCC imposed on Mr Mobasseri the sanction of erasure from the Register. That sanction is explained as follows at paragraph 6.30 of the Guidance for the Practice Committees including Indicative Sanctions Guidance (“ISG”):

“The ability to erase exists because certain behaviours are so damaging to a registrant’s fitness to practise and to public confidence in the dental profession that removal of their professional status is the only appropriate outcome. Erasure is the most severe sanction that can be applied by the PCC and should be used only where there is no other means of protecting the public and/or maintaining confidence in the profession. Erasure from the register is not intended to last for a particular or specified term of time. However, a registrant may apply for restoration only after the expiry of five years from the date of erasure.”

Ground 7 of the appeal was as follows:

“Further to Grounds 1 to 6 above, the Committee erred in determining a sanction of erasure, when suspension for 12 months would have been more appropriate when all of the factors were taken into account. The Committee failed to take properly into account the significant amount of remediation completed by the Registrant, in addition to the fact he had been under interim suspension from December 2021 to September 2023, being a period just shy 2 years, having been on conditions since October 2020, and then subsequently conditions were reimposed September 2023.”

I have already set out above the approach to an appeal on sanction that the parties agreed was appropriate, based upon the Sastry case. I approach this ground on that basis.

I should also add that at the hearing Mr Horne made it clear that, if I overturned the PCC’s decision on any of grounds 1 to 5, Mr Mobasseri’s preference was that I deal with the appeal on sanction on the basis of my decision on those grounds, rather than remit the decision on sanction to the PCC to determine on a fresh basis. Ms Tahta said the GDC was neutral on that point. Given those positions, I will determine ground 7 of the appeal rather than remit it to the PCC.

In considering matters at Stage 2 of the proceedings before it, the PCC first summarised its findings against Mr Mobasseri (as I have set out above at paragraph 34), and recorded that counsel appearing for Mr Mobasseri at the hearing before the PCC did not contest a finding of misconduct or of impairment. The PCC nonetheless set out its reasoning in respect of both misconduct and impairment. It first considered the GDC’s Standards for the Dental Team (September 2013), and noted:

“There were substantial failures in your standard of record keeping and significant clinical failings in terms of diagnostic assessments and treatment planning, which put patients at a real risk of harm. …

Your dishonesty in retrospectively altering numerous patient records, including to mislead the NHS as part of its monitoring process, and your dishonesty in submitting inappropriate claims for treatment are matters which clearly breach basic professional standards and fundamental tenets of the profession”

It concluded that the facts it had found in respect of both the clinical and probity failings were serious and amounted to misconduct.

The PCC then dealt with impairment, considering whether Mr Mobasseri’s conduct was remediable, whether it had been remedied and the risk of repetition. It also:

“…had regard to the wider public interest, which includes the need to uphold and declare appropriate standards of conduct and behaviour in order to maintain public confidence in the profession.”

The PCC considered that the clinical failings were remediable, through continued learning, reflection and evidence of embedded improvement in practice. It commended Mr Mobasseri on the steps he had already taken towards his remediation, recognising that he had insight into the importance of record keeping and had updated his practices. It also said:

“The Committee recognised the substantial remedial steps you have already taken, including comprehensive CPD activity and substantial changes in your record keeping practices, whereby your records are now contemporaneously maintained to a high standard. The evidence of your workplace supervisor is that you are a highly skilled, caring and competent practitioner who has taken these proceedings seriously and who has worked well under supervision to embed substantial improvements in his clinical practice.”

However, the PCC considered Mr Mobasseri had not yet fully remedied other clinical concerns, noting that his admissions had been limited to record keeping failings, and that he had denied the clinical charges relating to the taking of BPEs and the diagnosis and treatment of caries and periodontal disease prior to commencing Invisalign treatment. In relation to the failure to routinely carry out BPEs, the PCC added:

“No meaningful reflection on this was provided by you to the Committee, either at this stage of the hearing or as part of the factual inquiry, where your evidence to the Committee tended to be dismissive of the clinical importance and significance of BPE charting notwithstanding the CPD activity which you have undertaken.”

The PCC also recorded that Mr Mobasseri provided no meaningful reflection on his failure to recognise or treat caries and periodontal disease, and appeared to lack insight into the clinical importance of doing so before commencing orthodontic treatment.

The PCC summarised in respect of the clinical failings by saying that Mr Mobasseri’s failings in that respect appeared to be the result of attitudinal failings, rather than a lack of clinical skill and competence, and there was only limited evidence of insight and remediation in this attitudinal respect. It concluded that:

“You had placed patients at an unwarranted risk of harm in the past and, in the absence of further reflection and insight, are liable to do so again in the future.”

In relation to the acts of dishonesty in retrospectively altering clinical records and making inappropriate claims for treatment to the NHS, the PCC considered that was difficult to remedy, as it went to Mr Mobasseri’s character. It noted the repeated acts of dishonesty that had been carried out in various ways over an extended period:

“You falsified the clinical records of 29 patients, including with the intention of misleading the NHS as part of its monitoring processes in respect of 14 of those patients. You also dishonestly submitted inappropriate claims to the NHS for 6 patients. Whilst the sums involved were modest, the principle involved remains the same: you abused the trust which the NHS placed in you as a registered dentist when claiming from the public purse.”

The PCC noted that the altering of the clinical records placed patients at an unwarranted risk of harm, and that such alterations and the inappropriate claims were acts of dishonesty which breached “fundamental tenets of the profession and which bring the profession into disrepute.” In the PCC’s judgment, Mr Mobasseri remained liable to act dishonestly in the future due to the attitudinal nature of his misconduct.

The PCC examined Mr Mobasseri’s conduct against the four limbs of the test identified by Dame Janet Smith at paragraph 25.67 of her Fifth Shipman Report as an appropriate test for panels considering impairment of a doctor’s fitness to practise, and concluded that all four limbs were engaged, and that Mr Mobasseri’s fitness to practise as a dentist was currently impaired as a result of both the clinical and probity concerns, concluding:

“There remains a risk of repetition which puts the public at a risk of harm. The wider public interest also requires a finding of impairment to mark the seriousness of your dishonesty.”

The PCC then considered sanction, noting that its purpose is not to be punitive, but to protect the public and the wider public interest. It noted the following aggravating and mitigating factors present in this case:

“57.

The aggravating factors include:

- a risk of harm to patients in respect of both your clinical failings and your retrospective alteration of clinical records;

- premeditated dishonesty, including the deliberate alteration of clinical records; financial gain in respect of the NHS claims;

- misconduct sustained and repeated over an extended period;

- a blatant or wilful disregard of the systems regulating the profession, in that you falsified contemporaneous records to mislead the NHS and also made inappropriate claims to the NHS;

- attempts by you to cover up wrongdoing by retrospectively altering the contemporaneous records; and

- you demonstrate a lack of insight in that your insight in respect of both the clinical and probity failings is still developing.

58.

In mitigation, the Committee had regard to:

- your personal circumstances leading up to the incidents in question;

- the evidence of good conduct following these incidents;

- that you are otherwise of good character with no previous adverse fitness to practise history and have undertaken substantial remediation action in respect of the clinical aspects of your clinical failings, wholeheartedly embracing the interim conditions to which your registration is currently subject;

- the steps you have taken to avoid a repetition of your clinical failings, including substantial changes to your record keeping practices;

- the fact that you are remorseful; and

- the passage of time, with the last incident occurring in 2021.”

The PCC also recorded that it had regard to the “numerous testimonials” that had been given in support of Mr Mobasseri’s character and performance as a dentist, all of which it recognised spoke extremely highly of his clinical skills and his warm and personable nature. The PCC described them as “substantial and impressive and come from both colleagues and patients.”

The PCC then considered sanction in ascending order of restrictiveness. It considered that “no further action” or a reprimand would be wholly inappropriate, and that subjecting Mr Mobasseri’s registration to compliance with conditions of practice, whilst potentially being sufficient to address the clinical concerns, could not be designed to address in a measurable, workable and proportionate way the probity concerns. The PCC therefore next considered whether suspension for 12 months (with or without a review) would be appropriate, having regard to the factors indicated in support of suspension at paragraph 6.28 of the ISG, namely:

“- there is evidence of repetition of the behaviour;

-

the Registrant has not shown insight and/or poses a significant risk of repeating the behaviour;

-

patients’ interests would be insufficiently protected by a lesser sanction;

-

public confidence in the profession would be insufficiently protected by a lesser sanction;

-

there is no evidence of harmful deep-seated personality or professional attitudinal problems (which might make erasure the appropriate order).”

The PCC considered each of these factors to be present, except the last one. It said:

“The scale and extent of your dishonesty in retrospectively altering clinical records both in order to conceal inadequate clinical practice and to mislead the NHS, does suggest a harmful deep-seated professional attitudinal problem which engages the question of erasure.”

The PCC considered the indicated factors in support of erasure at paragraph 6.34 of the ISG and identified the following factors to be present to varying degrees:

“- serious departure(s) from the relevant professional standards;

- serious dishonesty, particularly where persistent or covered up;

-

a persistent lack of insight into the seriousness of actions or their consequences.”

The PCC also recorded:

“66.

The Committee noted that ‘submitting fraudulent NHS claims’ and ‘falsifying and/or improperly amending patient records’ are among the factors indicated at paragraph 59 of the ISG as being examples of dishonesty in professional practice which are capable of being ‘highly damaging to the dental professional’s fitness to practise and to public confidence in the profession’.

67.

The Committee also had regard to the over-arching objective set out under section 1 of the Dentists Act 1984, namely: ‘(a) to protect, promote and maintain the health, safety and well-being of the public; (b) to promote and maintain public confidence in the professions regulated under this Act; and (c) to promote and maintain proper professional standards and conduct for members of those professions.’ ”

It went on to say that it was not an easy decision for the PCC to make, and was one it had deliberated over at “considerable length”, and had been mindful of Mr Mobasseri’s extensive CPD records, testimonials and reflective statements. The PCC also accepted that the ISG was only guidance, and that erasure was “not an inevitability but is rather a matter for the careful judgment of the Committee in the circumstances of any given case.” However, the PCC determined that a period of suspension would be “insufficient to mark the seriousness of [Mr Mobasseri’s] dishonesty and to meet the wider public interest”, noting that he had abused the trust placed in him as a registered dentist, including that changes to the clinical records had been made in order “to mislead the NHS as part of its monitoring process” and that he dishonestly submitted inappropriate claims for treatment. It found that:

“Such conduct is fundamentally incompatible with your remaining on the Register and being allowed to enjoy the benefits and privilege of professional registration as a dentist.”

As a result, having regard to all the circumstances, the PCC determined (in the terms I have already set out at paragraph 35 above) that no lesser sanction than erasure would be sufficient. The PCC therefore directed erasure of Mr Mobasseri’s name from the Register.

Given my decision on the dishonesty points, the determinations on the various counts are largely, but not precisely, the same as they were before the PCC when it came to consider sanction. In particular, I have found that the PCC was wrong to find that Mr Mobasseri had been dishonest in relation to the inappropriate claims for Patients B, C, D, F and K. However, in respect of all of the other charges, I have held that the PCC was right to come to the determinations that it did. Those included charges of dishonesty on Mr Mobasseri’s part going beyond what he had admitted, and including dishonestly seeking to mislead the NHS about his record-keeping and about the fact he had not undertaken BPEs with certain patients, and in making a dishonest claim for treatment. Whilst therefore the landscape when it comes to consideration of sanction is not exactly the same as it was before the PCC, much of it is.

In Mr Horne’s submissions in support of ground 7, seeking to challenge the ruling on sanction, Mr Mobasseri drew attention to the following matters:

Mr Horne also noted the PCC’s statement that it had not found it an easy decision to make, suggesting that was a reflection of the fact that it was not a straightforward or clear case of erasure on the findings that the PCC had made.

Mr Horne made a number of submissions on the (contingent) basis that I overturned the PCC’s determinations on one or more of grounds 1 to 3 and 5, which largely I have not done. He also made submissions irrespective of whether any of his other grounds succeeded. Mr Horne contended that the PCC had erred in finding that he displayed evidence of a harmful deep-seated professional attitudinal problem. In relation to this, Mr Horne recognised that that finding was based upon the scale and extent of his dishonesty that occurred over an extended period in 2020, though he noted this had not been repeated, and stated that it was not based upon his clinical failings, which the PCC had concluded were remediable. That much is correct, although it does not seem to me to grapple with the points made by the PCC in relation to its determination on sanction about Mr Mobasseri’s dishonesty, and what it had found was his attitudinal problem.

The point which Mr Horne did seek to press in relation to this was that the PCC had, he contended, “failed to properly weigh important aspects of Mr Mobasseri’s stage 2 evidence, namely Mr Mobasseri’s participation and engagement in, and reflection on ethics courses, numerous testimonials which spoke of his honesty, and the professional opinion of Dr Hook, Medical Consultant Psychotherapist.” However, the PCC made it clear that it had taken this material into account. The PCC recorded (at paragraph 34) receiving the material containing “evidence of your reflections, remedial steps and [CPD] activity”, as well as noting the “numerous testimonials from patient and professional peers in support of your character and performance as a dentist.” It had received evidence (including oral evidence) from Mr Mobasseri’s workplace supervisor, who it said (at paragraph 35 of its determination) “spoke extremely highly of you both in terms of your clinical skill and performance and in terms of your professional attitude. He described you as a caring practitioner who puts his patients’ best interest first and who is fully committed to his remediation.” The PCC expressly referred to and recognised his CPD activity and other reflection and remediation when considering impairment (e.g. at paragraphs 46 and 47). When considering sanction, it expressly identified a number of matters as going to mitigation, including Mr Mobasseri’s good conduct following the incidents, his substantial remediation action and changes he had made, as well as referring to the testimonials (in the terms I have referred to at paragraph 145 above). The PCC again referred to Mr Mobasseri’s “extensive CPD records, testimonials and [his] reflective statements” before making its ultimate decision on sanction. This was all taken into account in its reasoning and its decision-making.

I was asked to read Dr Hook’s report (which I have done). Mr Horne’s skeleton argument drew attention in particular to the following passage from that report:

“Since his suspension and the therapeutic work he has undertaken alongside professional courses in ethics, professional values, honesty and probity he has gained a significant level of insight into these psychological processes and the path that has brought him to this point. In my opinion he has developed a good understanding of his basic attitudes and actions which have led to the charges against him. He acknowledges that he has been misleading and dishonest. I appreciate there are charges which he is contesting and on which the panel will rule which may shed further light on his level of insight.

Notwithstanding it is my opinion that as a result of his self-reflection and engagement with outside agencies, professional and therapeutic, he has recovered an appropriate level of probity and his capacity to be honest with himself and act according to his ethical values of providing good quality and respectful clinical care.”

It is right to say that the PCC did not expressly refer to Dr Hook’s report in the determination. As I have already said, the PCC did make it clear that it had taken account of Mr Mobasseri’s “CPD records, testimonials and [his] reflective statements”, which appears to have been intended to be a summary of the material that Mr Mobasseri had submitted to it for the purposes of the Stage 2 determination, and that material included Dr Hook’s report. It seems to me that the PCC intended to include that in its description of that information of which it had been mindful.

In any event, even if the position was the PCC had not taken it into account, or properly weighed it in its considerations, it seems to me that if it had done so it would not have made a difference to the PCC’s ultimate determination. The passage from Dr Hook’s report on which particular emphasis was placed (which I have set out above) recites work Mr Mobasseri had done, saying he had gained a significant level of insight. Other such references were included in other places in Dr Hook’s report. That was in any event recognised by the PCC in its determination, in particular in its discussion relating to impairment.

Dr Hook stated in his report that there were indications that Mr Mobasseri had started a necessary and longer-term process to develop an emotional level of insight, though noting further work would be need to extend and embed the changes had had started to make. He also noted (in the passage quoted above) that Mr Mobasseri acknowledged he had been misleading and dishonest, although appreciating that there were charges that he was contesting which, said Dr Hook, may shed further light on his level of insight. The PCC in its decision also recognised Mr Mobasseri’s admissions, both in relation to (some of) the clinical failings, and some acts of dishonesty. But, as noted by Dr Hook, he did not admit other charges, both in relation to the clinical and the probity charges, and (as predicted by Dr Hook) the PCC did find that shed further light on his level of insight. The PCC noted, for example, Dr Mobasseri’s attitude in his evidence at the hearing towards carrying out BPEs, saying (at paragraph 48) that his evidence tended to be dismissive of the clinical importance and significance of BPE charting notwithstanding the CPD activity he had undertaken. It recorded (at paragraph 49) that Mr Mobasseri had provided no meaningful reflection on his failure to ensure that active dental disease was under control before commencing orthodontic treatment, and appeared to lack insight into that. It recognised (at paragraph 53) that he had shown some insight into his dishonesty in respect of altering the records, but had some way to go to full insight. More generally, the PCC’s findings of dishonesty against Mr Mobasseri (which I have largely upheld) went significantly beyond what he had admitted and acknowledged, and the PCC was not only entitled, but also in my view correct, to find that he did not have a full insight into his own dishonesty.

The final point made in the passage I have quoted from Dr Hook’s report above was to the effect that, as a result of his self-reflection and engagement with outside agencies, professional and therapeutic, Mr Mobasseri had “recovered an appropriate level of probity and his capacity to be honest with himself and act according to his ethical values of providing good quality and respectful clinical care.” However, that does not take things any further. First, it did not reflect what the PCC ultimately found about the scope of Mr Mobasseri’s failings, in particular the scope of his dishonesty, such that in light of those findings (and Mr Mobasseri’s position in relation to them at the hearing) it is difficult to see how (at least at the time that Dr Hook had seen him) he could be said to have reached an appropriate capacity to be honest with himself about his failings. Second, even if he could be said to act according to his ethical values of providing good quality and respectful clinical care, that does not address the probity points, in particular where he had been found to be dishonest beyond his own admissions. Saying he would act according to his own ethical values in those circumstances assumes that those are appropriate which rather begs the question. Moreover, providing “good quality and respectful clinical care” is not the point on which the decision on sanction turned, and does not address the question of probity, which when it came to the sanction of erasure was key.

Accordingly, the fact that the PCC did not expressly deal with Dr Hook’s report makes no difference to the outcome.

In short, there is no defect at all with the PCC’s decision-making in relation to sanction. Mr Mobasseri’s criticisms in this respect are rejected.

Of course, as I have already recognised, the PCC was starting, when it came to sanction, from a different point than I have found it should have done. The PCC was taking into account not only the dishonesty that was admitted and the dishonesty I have upheld on this appeal, but also the dishonesty in respect of the ground 5(i) and (ii) conduct which I have not upheld. To that extent, the decision on sanction needs in any event to be re-examined. However, I do not consider that the removal of the dishonesty finding in respect of those charges makes any difference to the analysis carried out by the PCC in respect of sanction. All of the points made by the PCC still hold good, even in light of those aspects of its decision that I have overturned. Mr Mobasseri was dishonest, not only to the extent he admitted, but also beyond that, including in relation to falsifying his documentation to record BPEs that he never undertook (and to mislead a reader into believing he had undertaken them), and in relation to making a claim for treatment dishonestly.

The fact that the PCC recorded that it had not found the decision on sanction an easy one to make, and had deliberated over it at considerable length does not suggest weakness in its decision, or that removing the findings of dishonesty on the ground 5(i) and (ii) conduct means it should be reversed. The decision that the PCC reached was a clear one, supported by a proper analysis of the conduct as well as the factors that Mr Mobasseri had sought to be taken into account. As I have said, removal of the findings of dishonesty on the ground 5(i) and (ii) conduct does not disturb the analysis the PCC undertook.

In any event, the decision reached by the PCC was the correct one, not only on its findings, but also on the findings as they stand after this appeal (in other words, removing the PCC’s findings regarding dishonesty in the ground 5(i) and (ii) conduct). In light of what I have already said, I will summarise the main points in that regard:

As a result, the sanction imposed by the PCC was not wrong. It was justified and, in my view, was the correct sanction, not only on the PCC’s findings but also on the findings as they stand after my decision on the other grounds of appeal. The sanction of erasure was, and is, appropriate and necessary in the public interest. It cannot be said that it was or is excessive or disproportionate in the circumstances of this case.

Mr Horne also referred to the period of interim suspension that Mr Mobasseri has already served (between 7 December 2021 and 19 September 2023), but only suggested that might have an impact on the period of suspension order, if that were the sanction I had found to have been appropriate. It was not suggested that it had any impact if I found the sanction of erasure to have been appropriate (as I have). I therefore say no more about the effect of the period of interim suspension.

The PCC was right to determine that the sanction of erasure was appropriate (even in light of my setting aside of its findings of dishonesty in respect of the ground 5(i) and (ii) conduct). Ground 7 of the appeal therefore fails.