The Australian Health Practitioner Regulation Agency (AHPRA) reports that Majid Rahebi was convicted in the Local Court of New South Wales after pleading guilty to all charges for falsely representing that he was authorised or qualified to practise as a dentist and $18,750 for performing restricted dental acts. He was also ordered to pay approximately $19,950 in costs.
Rahebi’s MJ Dental Care Pty Ltd was also charged with falsely representing that Mr Rahebi was authorised or qualified to practise as a dentist. The company was fined $11,250.
The charges related to Mr Rahebi’s conduct between 15 November 2017 and 24 February 2018 while working at MJ Dental Care, located in Guildford West, NSW.
Rahebi was charged on 14 May this year with 44 counts of falsely representing that he was a registered dentist and 31 counts of performing a restricted dental act. Rahebi’s business,
AHPRA states that Rahebi has never been registered as a dentist or as any other health practitioner in Australia and holds no formal dental qualifications, although other reports indicate he had been a dental technician in Iran.
He had provided dental services through MJ Dental under the guise of being a registered dental practitioner. He represented himself to the public and to his patients as being authorised or qualified to practise in the dental profession. He consulted with patients and carried out dental treatment, including restricted dental acts. The restricted dental acts included significant invasive procedures such as root canal treatment, crowns and tooth extractions. Rahebi additionally possessed and administered anaesthetics (ie restricted prescription medications) without authorisation.
Considering potential revenue from the breaches of the law a higher scale of penalties might serve as a useful deterrent for such behaviour.
In June this year AHPRA noted Edward Lipohar was convicted in the Ringwood Magistrates’ Court after pleading guilty to three charges. They included holding himself out as (claiming to be) a dental specialist (orthodontist), and two charges of performing restricted dental acts on two patients.
The charges related to Lipohar’s conduct between November 2015 and September 2016 while working at an orthodontic business with premises in Victoria. During this time he attempted to carry out orthodontic procedures, including fitting corrective or restorative dental appliances. Orthodontic procedures are restricted dental acts, restricted to someone registered as a a dentist. Lipohar continued to attempt those treatments after being directed to stop by AHPRA in August 2016.
Lipohar has never held registration as a dental practitioner or as a registered health practitioner or student under the National Law with any National Board.
AHPRA comments
The court heard Mr Lipohar had little knowledge of the correct procedure and the patients he attempted to treat were unaware he lacked the necessary skills. Orthodontists identified significant problems with one patient’s teeth in subsequent years, while another experienced pain after Mr Lipohar fitted a retainer. Complaints were later submitted to AHPRA which filed charges against Mr Lipohar following an investigation.
At sentencing, Mr Lipohar was ordered to pay legal costs to AHPRA of $25,000 in addition to the $65,000 fine.'Outcomes of notifications to health practitioner boards: a retrospective cohort study' by Matthew J. Spittal, David M. Studdert, Ron Paterson and Marie M. Bismark in (2018) 16(38) BMC Medicine is a useful complement to 'Mind the Information Gap: Quantifying the Courts’ Role in Responding to Patient Harm, 1989 to 2013' by Wendy Bonython and Bruce Baer Arnold in (2018) 25(2) Journal of Law and Medicine 549-571, noted here.
Spittal et al note
Many countries entrust oversight of doctors and other health professionals to practitioner boards. A core mission of such boards is to protect the public from unsafe practice. Boards rely on patients, practitioners and their peers, employers and other agencies to bring risks to their attention and can employ a range of assessment and investigation processes to evaluate concerns about a practitioner’s health, performance or conduct. In cases where a practitioner poses a risk to patient safety boards can initiate a range of actions, including imposing conditions on the practitioner’s registration or suspending their licensure to practice. Actions that restrict ability to practice may have profound effects on affected practitioners – damaging livelihood, reputation, and potentially personal well-being. Imposing such actions therefore requires boards to chart a delicate course between protecting patients from harm and respecting the rights of practitioners.
Previous research has examined factors associated with disciplinary action against doctors. Studies have compared disciplined doctors with controls drawn from the broader medical workforce, with colleagues who were investigated or charged but not disciplined, and with colleagues who incurred less serious sanctions. In general, these studies identify several risk factors for incurring disciplinary sanctions, including male sex, late career stage, and practice in certain specialties (surgery, obstetrics and gynecology, psychiatry, and general practice). In addition, longitudinal studies of doctors have shown higher rates of disciplinary actions among physicians who performed poorly during residency and physicians who lack specialty certification. Relatively few studies have focused these types of analyses on nurses, and fewer still have examined pharmacists, psychologists, dentists, and other allied health professions. Moreover, this body of research tends to be profession specific. For example, no previous studies have directly compared doctors’ likelihood of regulatory action with risks experienced by other health practitioners.
In Australia, 14 health professions, including doctors, nurses, dentists, psychologists, and pharmacists, are regulated by a unified scheme that has operated since 2010. The scheme covers all states and territories, which creates a rare opportunity to use national, longitudinal data to examine the incidence and outcomes of “notifications of concern” (hereafter, “notifications”) relating to multiple professions. We conducted a retrospective cohort study of all notifications received by the national agency over a 2 year period. We estimated the incidence of notifications among health practitioners and tested for associations between various characteristics of notified practitioners (e.g., age, sex, profession) and notifications (e.g., issue type and source of notification) and the adjudicated outcomes of these notifications, particularly restrictive actions.
Our goal was to advance understanding of how this key regulatory regime operates. We were particularly interested in generating information with the potential to facilitate efficient adjudication and guide prevention efforts. We hypothesized that there would be systematic differences in rates of notification between professions, and that there would be relatively high rates of restrictive action against practitioners from certain professions (e.g., psychologists) and for notifications about certain issues (e.g., drug or alcohol misuse). ...The authors comment
This study of notifications lodged over a 2-year period against practitioners from 10 health professions found an overall rate of six notifications per 1000 practitioners per year. Doctors and dental practitioners had relatively high notification rates and nurses and midwives had relatively low rates. Final determinations were made on the majority of notifications within a year, although around one in ten took more than 2 years to resolve. In nearly 70% of cases, no further action was taken. About 10% of notifications resulted in restrictive actions, almost all of which involved some form of undertaking or conditions on practice. Only 21 notifications – about 0.3% of the total lodged – resulted in removal from practice. Notifications from peers and employers, notifications about health problems (particularly drug or alcohol problems), and notifications against dentists and psychologists had the highest odds of ending in restrictive actions...
The regulation of health practitioners in Australia has the primary objective of protection of the public by ensuring that only competent and ethical practitioners are registered. Handling notifications of concern about a practitioner’s health, conduct or performance looms as a key role of the national multi-practitioner regulation agency, with a complex apparatus for receiving, assessing and investigating notifications. This study suggests some interesting lessons for other international health practitioner boards.
We found that notifications to practitioner boards about the health, conduct or performance of a health practitioner are a rare event, and responses to notifications that involve restrictive actions, such as conditions on or removal from practice, are rarer still.
The probability of restrictive actions varied widely depending on the source of the notification (with notifications from peers more likely to result in restrictive action than those made by patients) and by profession (with notifications about doctors less likely to result in restrictive actions than those against other professions). The evidence that notifications made by fellow practitioners or employers are much more likely to lead to restrictive action than notifications made by patients and relatives or by complaint commissioners (which generally respond to patient complaints) is perhaps unsurprising. One possible explanation is that peers are better positioned to recognize legitimate bases for a notification than are patients. Relatedly, peers may refrain from notifying in all but the most egregious instances. A competing explanation relates to the adjudication process: notifications by peers may receive closer attention than notifications by patients. Given the increasing emphasis on the role of patients and families in patient safety, it would be of concern if issues raised by those on the receiving end of care are discounted in assessment processes dominated by peer opinion.
We found that nearly half of all notifications were due to concerns about performance issues, yet very few of these notifications resulted in restrictive actions. In contrast, relatively few notifications concerned health impairments, but a substantially larger proportion of them ended in restrictive actions. Part of the explanation for this difference may relate to issues of evidence and proof. What constitutes an unacceptable level of performance may be more difficult to determine, both for the notifier and the adjudicator, than the existence of an impairment that endangers safe care. Performance concerns inevitably raise the specter of judging what is acceptable care, an area where regulators (advised by members of the profession) have always treaded warily. Professional reticence to criticize poor care and vigorous defense lawyers likely also play a part.
Consistent with previous studies, notification rates were higher among male practitioners and older practitioners. However, there was no difference between males and females in the odds of restrictive action once a notification was received, and there was no trend for age.
Finally, the variation we observed between professions, both in the rate at which notifications were made, and the rate at which notifications ended in restrictive actions, is striking. Doctors, for example, had one of the highest rates of notifications, but those notifications were less likely to result in restrictive actions than in other professions. There are several possible explanations for such variation – they may be due to interprofessional differences, such as whether substandard care may directly cause harm (including pain), in the underlying rate of unprofessional behaviors, in the likelihood that any given episode of unprofessional behavior will be notified, in “case mix” (i.e., the nature and legitimacy of notifications), and in how strictly boards respond. We cannot disentangle these competing explanations because we did not observe unprofessional behavior directly, other than through the decisions of boards in cases that reach them.
