STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

JOSEPH L. RATCHFORD, )

)

Petitioner, )

)

vs. ) CASE NO. 84-4493

)

DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF DENTISTRY, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, this matter came to be heard on March 27, 1985 in Tampa, Florida before Donald D. Conn, a duly designated Hearing Officer of the Division of Administrative Hearings. The parties were represented as follows:

Petitioner: Michael S. Rywant, Esquire

250 Hyde Park Avenue Tampa, Florida 33606

Respondent: Drucilla E. Bell, Esquire

130 North Monroe Street Tallahassee, Florida 32301

Joseph L. Ratchford, D.D.S., hereinafter referred to as "Petitioner", requested a hearing regarding the grades he received on certain procedures in the clinical portion of the dental exam he took in June, 1984. Specifically, Petitioner objects to the grades he received on the Periodontal and Cast Class II Onlay Preparation procedures. At the hearing, Petitioner introduced four exhibits and two exhibits were introduced on behalf of the Department of Professional Regulation, Board of Dentistry, hereinafter referred to as "Respondent." Each party called two witnesses to testify. No transcript of the hearing was filed.

FINDINGS OF FACT

1. Joseph L. Ratchford is a graduate of the University of Georgetown School of Dentistry and took the Florida dental exam in June, 1984.

   
   

2. The clinical, or practical, portion of the dental exam consists of ten procedures and the examinee must obtain a total combined weighted grade of 3.0 to pass the clinical portion of the exam. Petitioner received a total overall grade of 2.96 and has questioned the grades he received on two of the ten procedures.

   
   

3. In grading the clinical portion of the exam, three examiners separately review and grade each procedure performed by the examinees. At each examination, approximately twelve to thirty examiners are used, and three hundred to four hundred candidates are examined. Each examiner must

   successfully complete an eight to twelve hour standardization exercise during which they are trained on the grading scale, procedures, and the criteria to be used in grading the clinical portion of the exam. The Board of Dentistry determines the criteria to be used in grading the exams and the grading scale. A perfect score is a "5" and a complete failure is a "O". Examiners are chosen by the Board of Dentistry based upon their successful completion of the standardization exercise and must also have been licensed in Florida for at least five years.

   
   

4. Petitioner received grades of 2, 3, and 5 from the three examiners grading the Periodontal procedure on his exam. This resulted in a grade of 3.33 on the Periodontal procedure. Petitioner objects to the grading of this procedure due to the wide disparity in the three examiners' grades.

   
   

5. The periodontal procedure is performed on a live patient and is an evaluation of the patient's teeth, root structure, and supporting structures. In grading this procedure, five criteria are used:

   
   

   1. Presence of stain on assigned teeth.

   2. Presence of supra-gingival calculus on assigned teeth.

   3. Presence of sub-gingival calculus on assigned teeth.

   4. Root roughness on assigned teeth.

   5. Tissue management.

      
      

      While several of these criteria are easily observable, criteria (c) and (d) are not, and in fact are sometimes hard to distinguish from each other. The grading system requires two points to be taken off when sub-gingival calculus is present on the assigned teeth (criteria c), and allows one to four points to be deducted for root roughness on the assigned teeth (criteria

      d).

      
      

6. Examiner 10 gave Petitioner a grade of 2 since the examiner found Petitioner was deficient on criteria (a), (c), (d) and (e). A grade of 2 is appropriate with these deficiencies, although such a grade may even be a bit high. Examiner 10 had participated in seven exams prior to the one in question and a post-exam evaluation of all examiners shows that Examiner 10 ranked 6th out of 18 examiners in terms of grading accuracy.

   
   

7. Examiner 35 gave Petitioner a grade of 3 since the examiner found Petitioner was deficient on criteria (c). A grade of 3 is mandatory is this situation since the presence of subgingival calculus requires two points to be deducted from the grade. Examiner 35 had participated in no previous exams but ranked 7th out of 18 examiners in terms of grading accuracy, according to a post-exam evaluation of all examiners.

   
   

8. Examiner 82 gave Petitioner a perfect score of 5, noting no deficiencies. This was the second exam Examiner 82 had participated in and he ranked 17th out of 18 examiners in terms of grading accuracy. Therefore, the perfect score which Petitioner received from Examiner 82 is the least reliable of the three grades on the Periodontal procedure since Examiner 82 had the worst ranking for accuracy among these three examiners, and was next to last among all examiners.

   
   

9. On the Cast Class II Onlay Prep procedure, Petitioner received grades of 1, 0, and 1. This resulted in a grade of .66 on this procedure. Petitioner

   objects to the grading of this procedure. He states he performed this procedure the way he was taught in dental school, he alleges that the comments of the examiners conflict, and he feels it is impossible to measure tooth reduction without an opposing model.

   
   

10. The Cast Class II Only Prep procedure is performed on a model, or mannequin, and consists of a restoration onlay wax-up on a posterior tooth. In grading this procedure five criteria are used:

    
    

    1. Outline form

    2. Depth

    3. Retention

    4. Gingival level

    5. Mutilation of opposing or adjacent teeth

       
       

11. Examiners 6 and 37 gave Petitioner a grade of 1. Examiner 6 commented on his score sheet that "Distal box too deep and undercut; excess facial cusp reduction." Examiner 37 commented that outline form was poor and "no lingual cusp protection." Examiner 15 gave Petitioner a score of 0 and commented that there was insufficient reduction of the functional cusp.

    
    

12. Each of these examiners had participated in at least two previous exams, and each had a high grading accuracy ranking according to a post-exam evaluation of all examiners. Specifically, Examiner 15 ranked 1st, Examiner 37 ranked 4th and Examiner 6 ranked 8th out of 18 examiners.

    
    

13. The comments of the examiners do not conflict and, in fact, do support the grades given. An examination of the mannequin used by Petitioner to perform this procedure (Petitioner's Exhibit 1) by a dental consultant who has been a licensed dentist in Florida since 1971, and who was accepted as a expert on the technical aspects of the clinical portion of the dental exam, confirms and supports the grades given by the examiners on this procedure. The major and significant deficiency on this procedure was Petitioner's failure to adequately reduce the functional or lingual cusp, and excessive reduction of the facial cusp resulting in the subject tooth being almost level. Although it is difficult to determine the amount of tooth reduction without an opposing model, and no opposing model was used in the exam, the teeth used for the exam mannequin are manufactured in large quantities from the sane mold or form. Therefore, variations in these model teeth before the procedures are performed are not visible to the naked eye. Improper reductions on these teeth are visible to the examiners who have seen this procedure performed many times on these same models, both in exams and in the standardization procedure.

    
    

14. According to an examination development specialist employed by Respondent who was accepted as an expert in testing and measurement, specifically for the dental exam, the grading of exams which involve hands-on, practical demonstrations of an examinee's skill level is not entirely objective. There is some subjectivity in assigning grades after criteria for each procedure are evaluated. This is why three examiners separately review each procedure, and the average of their grades is used. In addition, Respondent performs the standardization exercise prior to the exam and then evaluates each examiner's grades for accuracy after the exam in order to minimize disparity and the effects of subjectivity. Examiners who do not receive a good evaluation in the post-exam review are not used in subsequent exams.

    
    

15. Proposed findings of fact and conclusions of law have been submitted by the parties pursuant to Section 120.57(1)(b)4, F.S. A ruling on each

    proposed finding of fact has been made either directly or indirectly in this Recommended Order, except where such proposed findings of fact have been rejected as subordinate, cumulative, immaterial or unnecessary. Specifically, Petitioner's proposed findings numbered 7, 10, 11 and 12 are rejected for these reasons, and also because they are not based upon competent substantial evidence.

    
    

    CONCLUSIONS OF LAW

    
    

16. The Division of Administrative Hearings has jurisdiction over the parties and subject matter of these proceedings pursuant to Section 120.57(1), F.S.

    
    

17. Section 466.066(4), F.S., provides as follows in pertinent part:

    
    

    (4) To be licensed as a dentist in this state, an applicant must successfully complete the following:

    1. A written examination on the laws and rules of the state regulating the practice of dentistry;

    2. A practical or clinical examination, which shall be administered and graded by dentists licensed in this state and employed by the department for just such purpose. The practical examination shall include:

    1. Two amalgam restorations, and the board by rule shall determine the class of such restorations and whether they shall be

       performed on mannequins, live patients, or both;

    2. A demonstration of periodontal skills on a live patient;

    3. A final impression and articulation for a complete dental prosthetic;

    4. A cast gold restoration of a class to be determined by board rule on a mannequin, with attendant cast gold laboratory; and

    5. A demonstration of endodontic skills on a mannequin. If the applicant fails to pass

    the clinical examination in three attempts, he shall not be eligible for reexamination unless he completes additional educational requirements established by the board;

    * * *

    . . .. The board by rule shall determine the passing grade for each procedure, the acceptable variation for examiners, and the point of statistical invalidity of a procedure. No such rule shall apply retrospectively. The department shall require a mandatory standardization exercise for all examiners prior to each practical or clinical examination and

    shall retain for employment only those dentists who have substantially adhered to the standard of grading established at such exercise.

    
    

    The Board of Dentistry has adopted Rules 21G-2.13 and 2.19, F.A.C., which specify the grading system, criteria and requirements for the dental exam, as well as the method for administering the mannequin portion of the exam. Rules 21G-2.17 and 2.18, F.A.C., set forth the acceptable variation which will be allowed between examiners, and the method of determining reliability of clinical exam grades. The method of selecting examiners and the standardization exercise which all examiners must undergo is provided in Rule 21G-2.20, F.A.C.

    
    

18. The evidence presented establishes that Respondent's selection and training of examiners was in compliance with the above cited statute and rules, and that the exam was fairly and accurately graded by qualified examiners in accordance with rule standards. The comments of the examiners and the expert witnesses who testified support the grades given by the examiners on the two procedures Petitioner has questioned.

    
    

19. Petitioner has failed to meet his burden of proving that he passed the dental exam, that the grades he was given were in error, or that Respondent acted arbitrarily and capriciously in failing to give him the grades he deserved on these two procedures. Florida Department of Transportation v. J.W.C. Co., Inc., 396 So.2d 778 (Fla. 1st DCA 1981); State ex rel. Glasser v. Pepper, 155 So.2d 383 (Fla. 1st DCA 1963).

RECOMMENDATION

Based upon the foregoing, it is recommended that Respondent enter a Final Order upholding the grades given to Petitioner and denying the relief sought by Petitioner.

DONE and ENTERED this 19th day of April, 1985 at Tallahassee, Florida.

DONALD D. CONN, Hearing Officer Division of Administrative Hearings The Oakland Building

2009 Apalachee Parkway

Tallahassee, Florida 32301

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 19th day of April, 1985.

COPIES FURNISHED:

Drucilla E. Bell, Esquire Department of Professional

Regulation

130 North Monroe Street Tallahassee, Florida 32301

Michael S. Rywant, Esquire

240 Hyde Park Avenue Tampa, Florida 33606

Fred Roche, Secretary Department of Professional

Regulation

130 North Monroe Street Tallahassee, Florida 32301

Salvatore A. Carpino, Esquire Department of Professional

Regulation

130 North Monroe Street Tallahassee, Florida 32301

Docket for Case No: 84-004493

Orders for Case No: 84-004493