Health and Disability Commissioner investigates struck-off dentist Bharath Subramani, finds more breaches

More complaints about the poor practices of a struck-off dentist have come to light.

They include a patient who suffered extreme pain after a piece of tooth was left in his gum, and another who was hospitalised after her cheek was pierced with an airflow polisher.

Former Greymouth dentist Bharath Subramani, known as Barry Subramani, was banned by the Dental Council in 2023 from practising for three years after several upheld complaints.

Today, the Health and Disability Commissioner released an 86-page report focused on three further complaints.

Deputy Commissioner Vanessa Caldwell found Subramani breached several aspects of the Code of Health and Disability Services Consumers' Rights (the Code) when he provided dental services to the complainants, and has recommended that he apologise.

A 'floating' piece of tooth

According to the report, a 55-year-old patient, referred to as Mr C in the findings, attended eight dental appointments with Subramani between December 2021 and January 2022, while he was under supervision.

A significant amount of treatment was performed, including a tooth extraction.

After, Mr C suffered chewing problems and an infection.

An "excessively painful" large lump in his cheek also developed and at the following appointments, he queried Subramani about whether it could be a "floating piece of tooth".

He told the patient it was his jawbone and reassured him the area was healing well.

However, the pain continued and eventually, "a large piece of tooth came out", where the lump had been.

He showed Subramani, who reportedly laughed it off.

In relation to Mr C's treatment, Caldwell found Subramani had failed to advise of the potential chewing issues after the extraction, did not order an X-ray when necessary, failed to obtain informed consent for multiple procedures and had incomplete and confusing clinical notes.

Mr C told the HDC he was "very disappointed in the whole experience" with Subramani.

He said he complained to prevent the poor treatment of future patients.

Urgent filling leads to thousands of dollars in work

Another patient visited Subramani urgently in April 2018 as he believed a filling had fallen out and was in pain.

The 35-year-old told the HDC that while only one tooth had been bothering him, Subramani worked on three others, saying they needed attention.

Subramani also made him a "type of mouthguard," he said was required and charged him $1300.

His notes said the patient, referred to as Mr B, had needed three fillings, and a bite splint to assist his teeth grinding.

Mr B was told more fillings would be needed, for which Subramani quoted him $400.

But it turned out to be an exam, scale and polish plus five fillings and he was charged $1425.

The man complained to the dental practice, then later the HDC, that he experienced ongoing pain after his treatment with Subramani.

"I have had nothing but trouble since he did this work in 2018, spent thousands of dollars, seen [four] different dentists at different times resulting in [two] of the teeth he worked on ultimately being removed," he said.

Caldwell's findings concerning Mr B included Subramani's use of outdated materials and incomplete procedures, that he failed to properly diagnose or treat infection, and to provide or document clear treatment plans or consent.

Pierced with an airflow polisher

The third complainant, aged 75 at the time of treatment between March and April 2018, had a tooth removed by Subramani at her initial appointment.

After, Subramani told the woman, referred to as Ms A, that she ground her teeth and needed something for it.

She disagreed and told the HDC that he was "quite insistent" that she ground her teeth and was "very confrontational".

At a subsequent appointment, Ms A returned for a scale and polish.

Subramani tried to polish her teeth using an airflow polisher, but it slipped and pierced the tissue of her cheek.

She told the HDC that she "shot upright and could not breathe," and it felt like a "choking sensation", which caused her throat, cheek, and neck to swell.

Ms A, who was left alone for a few moments, began to hyperventilate, was very upset and frightened and was later taken to hospital by a friend.

There, she saw a doctor who was concerned she had surgical emphysema that was "well up in her face", she told the HDC.

She was observed for about 12 hours then sent home. However, she remained sick for about 10 days.

She told the HDC she did not choose to have scaling with air polishing, was not informed of the risks or benefits, and subsequently did not give her verbal consent for this treatment.

Ms A said the incident left her feeling traumatised, and she has been too fearful to visit a dentist since.

Among her findings, Caldwell made several concerning Subramani's failure to use the airflow polisher appropriately.

It was also found that treatment plans were inappropriate for the condition, there was a lack of explanation and consent, and Subramani did not seek second opinions or proper supervision when required.

Again, several breaches were identified.

The HDC's recommendations

Caldwell's report, which included expert clinical advice, identified a pattern of unsafe practice and poor patient engagement by Subramani.

In making her recommendations, she noted the action already taken by the Dental Council.

As Subramani was no longer practising, she ordered him to provide a formal apology to the complainants and to provide the HDC with evidence of the training courses he had attended.

Caldwell also recommended that Subramani undertake further education and training before he became registered with the Dental Council again, and that the council conduct a competence review.

Guilty of professional misconduct

According to the report, the council had referred Subramani to a Professional Conduct Committee in February 2019 after a string of complaints.

The committee went on to find that a charge should be brought against him before the Health Practitioners Disciplinary Tribunal.

In February 2022, Subramani admitted and was found guilty of a charge of professional misconduct at the tribunal hearing relating to his treatment of 11 patients between October 2017 and October 2018.

The charge included 39 incidents of misconduct, which did not include the three complaints referred to in the HDC report. As a result, he was fined, ordered to pay costs and deregistered, which he appealed.

Then, the following month, the HDC made public interest referrals to the Dental Council regarding two of the complainants in the report.

The HDC had become aware that Subramani was still able to practise subject to supervision by a dentist appointed by the council in 2020, until an appeal made by him to the High Court had been heard.

At that time, HDC had not received the third complaint in the report but it has since been referred.

In November 2023, the council confirmed that Subramani's appeal had been heard and that the High Court had upheld the decision to deregister him. It ruled that he was not to practise for three years from October 2023.

* This story originally appeared in the New Zealand Herald.