vs. ) CASE NO. 81-2950
Respondent. )
Pursuant to notice the Division of Administrative Hearings, by its duly designated Hearing Officer, Michael Pearce Dodson, held a final hearing in this case on March 12, 1982, in Ocala, Florida. The following appearances were entered:
For Respondent: John E. Griffin, Esquire
Assistant Attorney General Department of Legal Affairs The Capitol, Room 1601 Tallahassee, Florida 32301
These proceedings began on October 20, 1981 when Petitioner, Parimal P. Chokhawala, made a request that the grades he received on the June, 1981, dental clinical examination administered by the Respondent, Department of Professional Regulation be changed. By a letter dated November 25, 1981, the case was forwarded to the Division of Administrative Hearings for the assignment of a Hearing Officer and the scheduling of a final hearing.
At the final hearing Petitioner offered Exhibits 1 and 2, which were received into evidence. Respondent offered Exhibits A through E, which were received into evidence. Also received into evidence were Joint Exhibits 1A, 1B, 1C, 1D, 1E, 2, 3, 4 and 5. Subsequent to the hearing Respondent filed Proposed Findings of Fact and Conclusions of Law and Recommended Order. Dr. Chokhawala filed a letter of response dated April 16, 1982, in which he proposed certain factual findings. To the extent that the proposed findings submitted by the parties are not reflected in this order, they were rejected as being either not supported by admissible evidence or as being irrelevant to the issues determined here. Agrico Chemical Company v. Department of Environmental Regulation, 356 So.2d 759, 763 (Fla. 1st DCA 1979).
In June of 1981 Petitioner was a candidate to be licensed as a dentist and he took the clinical (practical) portion of the dental examination. A final score of 3.0 as a general average was needed to pass the clinical portion. Petitioner obtained a failing score of 2.97.
The clinical examination administered by Respondent in June, 1981 consisted of the following procedures, weights and percentages:
Percentage of
Procedure Weight Final Grade Class II Amalgam
Preparation 2/3
20 percent
Restoration 1/3
Periodontal
Definitive debridgement (root
planing, curretage, deep scale) 3/3 20 percent Endodontics
Access preparation - posterior
tooth 1/2
Access preparation - anterior
tooth 1/2
Denture
Impression and articulation of an edentulous mouth
impression 1/2
Occlusal Registration and
Transfer 1/2
Cast Gold Restoration
Preparation 2/3
Restoration 1/3
Pin Amalgam
Preparation 2/3
Restoration 1/3
15 percent
20 percent
15 percent
10 percent
The Petitioner's final score on the clinical portion of the June, 1981 examination was based on the following scores:
| Final Grade | Percentage |
On | of Final |
Procedure | Scores | Procedure | Grade |
Class II Amalgam
Preparation (2/3) 3,1,0,3,4
Restoration (1/3) 3,2,2 Periodontal
Definitive
2.6 x .20
debridgement (3/3) 3,3,2 2.67 x .20 Endodontics
Access Preparation - posterior tooth (1/2) 4,3,4
Access Preparation -
anterior tooth (1/2) 3,5,3 Denture
Impression and articulation of an edentulous mouth
impression (1/2) 3,2,4
Occlusal Registration
and Transfer (1/2) 3,2,2 Cast Gold Restoration
Preparation (2/3) 5,3,4
Restoration (1/3) 4,3,2 Pin Amalgam
Preparation (2/3) 4,2,3
Restoration (1/3) 5,3,4
3.67 x .15
2.67 x .20
3.67 x .15
3.33 x .10 Final Grade 2.97
The following grading system was used for the June, 1981 clinical examination:
- Complete failure
- Unacceptable dental procedure
- Below minimal acceptable dental procedures
- Minimal acceptable dental procedures
- Better than minimally acceptable dental procedure
- Outstanding dental procedure
To grade the June, 1981 examination Respondent selected approximately 23-26 Florida licensed dentists who had been engaged in the practice of dentistry for a minimum of five years prior to the examination. Potential examiners were pre-screened by having them grade models of various preparations and restorations which were prepared by Respondent. Those potential examiners who graded the models consistently within the pre-determined score established by Respondent were invited to act as examiners. Prior to arriving at the examination site the examiners were sent a booklet containing instructions and procedures to be followed during the examination. The examiners were also sent a copy of the instruction booklet provided the candidates. One day prior to the first exam day all examiners attended an eight-hour standardization program conducted by the chairmen of the various departments of the University of Florida dental school. All the examiners attended regardless of whether they had previously attended a standardization exercise.
The purpose of standardization is to promote consistency and objectivity among examiners in the application of the grading criteria. During standardization the examiners reviewed and discussed the 0-5 grading system and the grading criteria for each procedure and took a dry run examination. The scores given by the examiners on the various models during this dry run were posted and discussed by the examiners and those scores which deviated from the pre-determined score were discussed to eliminate any examiner subjectivity or misapplication of grading criteria.
Each procedure on the clinical examination was graded by three examiners and the grades were averaged to determine the final score for that procedure. The examiners graded independently of each other and did not know the score any other examiner might have given the candidate or whether he was the first, second or third examiner. Further, grading was not done in the presence of the candidate and only the candidate's number was known to the examiner. A fourth and fifth examiner was used to grade a procedure if two of the three grades given were more than two units apart (i.e. 1 and 4, 2 and 5, etc.). However, the fourth and fifth examiner would not know if he was the first, second, third, fourth or fifth grader.
Cast Gold (Preparation)
Candidates at the June, 1981 examination were required to prepare a cast gold class II mesial occlusal distal (MOD) only on a bicuspid ivorine tooth in a dentoform contained in a mannequin. The MOD only would replace the buccal and lingual cusps.
The grading criteria for the cast gold preparation procedure were discussed at standardization and were contained on the grade sheets utilized by the examiner.
On the cast gold preparation procedure the Petitioner received the scores of 5, 3 and 4 for a final averaged score of 4 on that procedure. Examiner number 10 gave Petitioner a 5 and did not mark the criteria comment section of the grade sheet. Examiner number 35 gave Petitioner a 4, marking criteria comment number 3, indicating a deficiency in the retention form of the preparation. Examiner number 15 gave Petitioner a 3, marking criteria comment numbers 1 and 3, indicating a deficiency in both outline form and retention form. Petitioner contests the individual grade of 3 that he received on that procedure from Examiner number 15. More specifically, he takes issue with Examiner number 15's comment on the grade sheet that there were deficiencies in
the outline form of the preparation. Without explaining why he felt his outline form was not susceptible to the grade of three, Petitioner simply asserted that it was correct when compared to outline forms illustrated on pages 156-158 in the text Basic Operative Dentistry Procedures by Bell and Granger. On cross- examination, Petitioner agreed that the preparation was not perfect because there were some problems with the preparation's retention form. Petitioner further agreed on cross-examination that dentists can reasonably differ on the significance of criteria used in grading dental procedures and that he recognized that the reason Respondent used three examiners for each procedure was to be as fair as possible to the candidates by minimizing examiner differences in grading.
With respect to the cast gold preparation no evidence was presented that the grades received by Dr. Chokhawala were given capriciously, unjustly or in a manner contrary to the properly established grading procedures. Respondent presented expert testimony, which is given conclusive weight here, that the grades given Petitioner are fair and well within the parameters of professional judgment.
Cast Gold (Restoration)
Candidates at the June, 1981 examination were required to prepare a mesial occlusal distal only to be seated on their previously prepared ivorine tooth. The candidates were to finish the margins of the casting on a removable die but they were not allowed to do any finishing of the margins while the casting was on the ivorine tooth.
The grading criteria for the cast gold restoration procedure were discussed at standardization and were contained on the grade sheets utilized by the examiners.
On the cast gold restoration procedure the Petitioner received the scores of 4, 3 and 2 for a final averaged score of 3 on that procedure.
Examiner number 10 gave Petitioner a grade of 4, noting criteria deficiencies of margins and surface finish. Examiner number 15 gave Petitioner a grade of 3, noting criteria a deficiency of surface finish and also writing on the grade sheet that the ivorine tooth had been sanded to finish the onlay. Petitioner received a grade of 2 from Examiner number 35, who marked deficiencies in the margins, functional anatomy and proximal contour. Petitioner contests the grade of 2 that he received from Examiner number 15. More specifically, he takes exception to Examiner number 35's reference on the grade sheet to functional anatomy and proximal contour. Petitioner stated that he felt there was proper occlusion to allow the opposing teeth of each jaw to be in optimal contact during occlusion and that the proximal contour and anatomy was sufficient to establish proper contact with adjoining teeth. However, both during his direct testimony and on cross-examination the Petitioner agreed that the functional anatomy and proximal contour of the restoration could not be determined at the hearing because the ivorine tooth containing the restoration had to be placed in the dentoform before one could determine its relationship to adjacent and opposing teeth and he did not have a dentoform with him.
With respect the cast gold restoration procedure no evidence was presented that the grades received by Dr. Chokhawala were given capriciously, unjustly or in a manner contrary to the properly established grading procedures. Respondent presented expert testimony, which is given conclusive weight here, that the grades given Petitioner are fair and well within the parameters of professional judgment.
Class II Amalgam (Preparation)
Candidates at the June, 1981 examination were required to prepare a tooth with a class II cavity. It was the candidate's responsibility to present a live patient with a tooth that had good contact and occlusion and without any existing restoration. The tooth was to have decay that barely penetrated the dentin and which permitted an ideal cavity preparation.
The grading criteria for the amalgam cavity preparation procedure were discussed at standardization and were contained on the grade sheets utilized by the examiners. Complete removal of decay was required and if a candidate did not meet this requirement, the examiners were instructed to give a grade of 0.
On this portion of the exam the Petitioner received scores of 3, 1, 0,
3 and 4 for a final average of 2.2. Examiner number 45 gave Petitioner a 3. He indicated a deficiency in the outline form in the presence of unsupported enamel. Examiner number 32 gave Petitioner a 1. He marked deficiencies in the depth preparation and retention form and indicated the presence of decay in the preparation. Petitioner received a 0 from Examiner number 5 who indicated that decay remained in the preparation. Petitioner received a 3 from Examiner number
10 who noted deficiencies in the outline form and depth preparation. Examiner number 38 gave Petitioner a 4. He indicated a deficiency in the outline form. Both Examiner number 32 and number 5 sent a special instruction sheet back to Petitioner requesting him to remove remaining decay prior to inserting the amalgam. Petitioner challenges the grades of 0 and 1. He asserts that they are erroneous because he did not leave any decay in the preparation.
Petitioner knew that decay had to be removed and he was certain that he removed all the decay. He relied on the fact that 3 of the 5 graders did not find decay. Petitioner believed examiners could disagree on the extent of decay in a tooth but not on its presence.
Whether or not decay still remains in an excavation is a matter about which dentists may reasonably disagree. The fact that three examiners did not see decay remaining in Dr. Chokhawala's work does not conclusively establish that there was actually no decay. Those examiners' opinion does not automatically preclude other examiners from reasonably finding decay present.
With respect to the Class II amalgam preparation no evidence was presented that the grades received by Dr. Chokhawala were given capriciously, unjustly, or in a manner contrary to the properly established grading procedures. Respondent presented expert testimony, which is given conclusive weight here, that the grades given Petitioner are fair and well within the parameters of professional judgment.
Class II Amalgam (Restoration)
Candidates at the June, 1981 examination were requested to place an amalgam restoration in the tooth prepared during the amalgam cavity preparation procedure.
The grading criteria for the amalgam restoration procedure were discussed at standardization and were contained on the grade sheets utilized by the examiners.
On the amalgam cavity restoration Petitioner received scores of 3, 2 and 3 for a final average of 2.66. Examiner number 17 gave Petitioner a grade of 3. He found deficiencies in the criteria of functional anatomy and proximal contour. Examiner number 5 gave Petitioner a grade of 2 and marked deficiencies in the restoration's functional anatomy, contact, and margins. Petitioner received a grade of 3 from Examiner number 35 who noted deficiencies in the functional anatomy and the margins. Admitting that his restoration was not of good quality, Petitioner maintains that his low grades on this procedure were the direct result of not being given adequate time to complete the procedure.
He suggests that his grade on the pin amalgam restoration procedure, which procedure he claims is more difficult, be utilized as demonstrating his skill when accorded the proper time.
The total examination time allotted for the Class II amalgam restoration exercise was two-and-one-half hours. When a candidate completed the preparation portion discussed above, his work was graded before he went on to complete the restoration. In Dr. Chokhawala's case it took approximately 50 minutes for his preparation to be graded. That left him approximately 27 minutes of the two-and-one- half-hour period in which to complete the restoration. That is an adequate amount of time in which to competently complete the filling. The applicants were informed during their pre-examination briefing that the preparation grading process would take between 30 and 45 minutes. Performance on the pin amalgam restoration procedure is not the equivalent of properly executing a Class II amalgam preparation and restoration. Petitioner's factual contention that his grade on the pin amalgam restoration proves he can adequately make a Class II amalgam restoration is not correct.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties and the subject matter of this case. Section 120.57(1), Florida Statutes (1981).
When an applicant challenges the grades he received on a professional licensing examination he must show by a preponderance of the evidence that the grades in issue were arbitrarily or capriciously given by the examining agency. This rule is set out in State ex rel. Glasser v. Pepper, 155 So.2d 383, 384 (Fla 1st DCA 1963). No proof was presented of capriciousness or arbitrariness by Respondent in awarding grades to Dr. Chokhawala. The proof here shows only that professionals do not make identical conclusions when grading an applicant's performance. The evidence does show that all the grades awarded Dr. Chokhawala were within the range of reasonable professional judgment. In this case Petitioner has not made any showing of an entitlement to new grades or a passing score on the clinical examination. In re Altchiler, 4 FALR 724A (Florida, Board of Dentistry, Final Order, January 16, 1982).
Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Dentistry enter a Final Order denying the
application of Dr. Chokhawala for licensure as a dentist on the grounds that he failed to successfully pass the clinical examination as required by Section 466.006(4)(b), Florida Statutes (1981).
DONE and RECOMMENDED this 26th day of August, 1982, in Tallahassee, Florida.
MICHAEL P. DODSON
Filed with the Clerk of the Division of Administrative Hearings this 26th day of August, 1982.
John E. Griffin, Esquire Assistant Attorney General Department of Legal Affairs The Capitol, Room 1601 Tallahassee, Florida 32301
1715 Northeast 36th Avenue, No. 6
Samuel R. Shorstein Secretary
