MAR-19-20Rg 16:19 PHA Mar 19 2009 16:37 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, VS. CASE NUMBER: 2007-14963 EBRAHIM MAMSA, D.D.S., RESPONDENT. ADMINISTRATIVE COMPLAINT ———€OMES-NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Dentistry against the Respondent, Ebrahim Mamsa, D.D.S., and in support thereof alleges: 1. Petitioner is the State Department charged with reguiating the practice of Dentistry pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes, and Chapter 466, Florida Statutes. 2. At all times material to this Complaint, Respondent was 4 licensed dentist within the State of Florida, having been issued license number DN 10792. 3. Respondent's last known address of record is: 10285 Cove Lake Drive, Orlando, Florida 32836. P.ae/35 an. on “lh MAR-19-20Rg 16:19 PHA Mar 19 2009 16:37 4. The Respondent provided treatment to Patient L.S. on or about January 15, 2007, and on or about January 23, 2007. 5. Patient L.S. presented to Respondent on or about January 15, 2007, as a new dental patient. Respondent was working at Spruce Creek Dental office that was previously and/or currently owned by Respondent. Notwithstanding the legal ownership of the dental practice, Respondent operated an independent dental patient practice separate and exclusive from Dentist J.S. located at the Spruce Creek Dental office. Respondent and Dr. J.S. did not share treatment of patients. 6 More importantly, Respondent did not have an agreement with Dr. J.S. to provide any emergency care in the absence of Respondent. 7. On or about January 15, 2007, Respondent performed a clinical and radiographic examination. Respondent diagnosed Patient L.S. as having “Type Four Perio Upper lower Type IL...” Respondent did not perform a comprehensive periodontal examination, to include full pocket depth probing and charting. However, Respondent treatment planned the restoration of Patient L.S.’s dentition by extraction of the remaining natural maxillary teeth and the insertion of an immediate full denture. Respondent treatment planned the lower dentition with extraction of teeth numbers 22 and 26 and - 2 . J:\PSU\Medical\Dentistry\David Flynn\admin Compiaints\Ac's 19SEPDB\Mamsa(x)(m)(abandonment).doc P3735 MOR-19-2089 16:19 SHCA Mar 19 2009 16:37 periodontal therapy and fabrication of a lower removable partial denture. Respondent proceeded with taking impression of Patient L.S.’s upper and lower dentition. 8. On or about January 15, 2007, Respondent failed to accurately and/or adequately chart Patient L.S.’s dentition. Respondent’s anatomical charting form simply marks the missing teeth and does not chart caries, existing restorations, and/or proposed restorations. Additionally, Respondent took five periapical radiographs and failed to take a panoramic survey to vefect the-entire upper jaw-bone-cf-Patient L.S-netwithstanding-that he treatment planned: an upper complete full denture. The periapical radiographs indicate that tooth number 4 is present and tooth number 5 is missing. However, Respondent's anatomical chart indicates tooth number 4 is missing and tooth number 5 is present. Further, Respondent charted tooth number 27 as missing and tooth number 26 as present. However, tooth number 27 appears to be radiographically present, and Respondent failed to take a radiograph that would adequately depict tooth number 26. 9. On or about January 15, 2007, Respondent failed to comprehensively document the clinical examination(s)/test(s) performed and the results thereof and the results of the radiographic examination to justify -3- 2:\PSU\Madical\Dentistry\David Flynn\admin Complaints\AC's LOSEPOE\Mamea(x)(m)(abandonment).dac P4735 MAR-19-29N9 16120 Mar 19 2009 16:38 AHCA his recommended course of treatment of extracting tooth numbers 22 and 26/27. There is not any periodontal probing noted, tooth mobility noted, and/or presence of caries or oral pathology noted that would justify the entire recommended course of treatment, 10. On or about January 15, 2007, Respondent developed a treatment plan for a total cost of $ 5,475.00 dollars which was immediately paid by Patient LS, after establishing a line of credit. 11. On or about January 23, 2007, Patient L.S. presented back to ‘Respondent; According to-Respendent’s treatment records dated January 23, 2007, Respondent extracted Patient L.S.’s teeth numbers “22, 27." Respondent failed to document the type and amount of local anesthesia used during the extraction. Respondent inserted an immediate lower partial denture and re-scheduled Patient L.S. for her next appointment a week later. Respondent did not note any adjustment made to the immediate lower partial denture which would be a necessity since Patient L.S. was not presenting back fora week. This was the last time Patient L.S. saw Respondent. 12. Patient L.S. asserts that she started having pain associated with the immediate jower denture almost immediately after insertion. Patient LS. asserts she attempted to contact Respondent. The treatment record does . 4 . J:\PSU\Medical\Dentistry\David Flvan\Admin Compiaints\AC's 1SSEPOB\Mamsa(x)(m)(abandonment).doc P.@5/35 NeR-19-2009 16:20 auca Mar 19 2009 16:38 indicate that on or about January 30, 2007, Patient presented to Spruce Creek Dental and a bite registration was taken for the upper denture. 13. Patient LS. asserts that she continued to have pain associated with the lower partial and attempted to contact Respondent with no success and that her appointments were simply canceled. Patient L.S. asserts that when the pain became unbearable she contacted Respondent's office and demanded to be seen. At this point, Patient L.5. was informed that Respondent was not in the area and would not be back for a month. _patient- :S-asserts-that-her- husband-demanded_treatment and that.ts when she was scheduled to be seen by Dr. 1S. 14. Dr. 1.S. corroborates Patient L.S.’s assertion and asserts that Patient L.S. was a patient of Respondent’s and that sometime in February of 2007, Respondent left his practice (referencing Respondent's practice), without notifying anyone to include Respondent’s own patients. Consequently, he agreed to see Patient L.S. due to her pain, swelling, and ill-fitting dentures. Dr. 1.5. asserts he saw Patient L.S. as a courtesy because she was in agony and Patient L.S. was not his patient of record. Patient L.S. asserts that Dr. J.S. was uncomfortable with treating her because he was not her dentist of record. -5- 3:\PSU\Medical\Dentistry\David Flynn\admin Complalnts\AC's JOSEPOS\Mamea(x)(m)(abandonment).doc P6735 MAR-19-29N9 16120 auca Mar 19 2009 16:38 15, From on or about March 5, 2007, through on or about April 12, 2007, Dr, J.S. took over treatment of Patient L.S. until he was notified by Respondent that he did not have authority to treat his patients and that he would be returning in a couple of weeks. Patient L.S. was notified that Respondent would be back in a couple of weeks and she needed to present to Respondent. 16. Patient L.S. refused to be seen by Respondent after he simply disappeared after beginning a multi-appointment dental procedure. . 17, After on or about January 23, 2007, after extracting two lower temporary partial denture, without notification to Patient 1.5. or the dental office Respondent practiced in, Respondent was unavailable to-proceed with Patient L.S.’s imminent dental care. Respondent unilaterally abandoned Patient LS. in the middle of treatment that was not complete after on or about January 23, 2007, without notification and without arranging for the continued treatment of Patient L.S. 18. The prevailing standard of care in diagnosis and treatment when measured against generally prevailing peer performance requires a dentist to properly perform an adequate comprehensive intra-oral and extra-oral clinical examination of the patient to include, but not be limited to, oral cancer screening, oral pathology and disease screening, tooth charting, periodontal -6* 3:\PSU\Medical\Dentstry\David Flynn\Admin Complaints\AC's {OSEPOB\Mamsa(x)(mn)(abandonment).doc PaaS MOR-19-2089 16:20 SHCA Mar 19 2009 16:38 examination and periodontal probing, when presented with a patient for an initial comprehensive examination. 19. Moreover, the prevailing minimum standard of dental care requires a dentist to take a full series set of radiographs and/or a panorex which details the upper and lower jawbone so the dentist is fully aware of any and all oral pathology present before beginning the fabrication of dentures for a patient. Additionally, a dentist should also perform a periodontal examination with periodontal probing and charting before beginning restorative denture treatment. The dentist should then treat any periodontal pathology before proceeding with denture fabrication and/or inform the patient of the periodontal pathology and treat or refer the patient for an evaluation before beginning restorative dentistry. A dentist should not fabricate a denture on untreated periodontally involved teeth. 20. Further, the prevailing minimum standard of dental care requires that a dentist performing any dental procedure complete the dental procedure in full. However, if during treatment of the patient, any issue materializes which compromises the completion of treatment, the dentist must not unilaterally terminate treatment of the patient or abandon treatment. The dentist must fully communicate to the patient the necessity of discounting treatment and if it Is manifested that treatment must be discontinued, the dentist shall inform the patient of any and all inherent -7- J:\PSU\Medical\Dentistry\David Flynn\admin Complaints\ac's 1 9SEPOR\Mamsa(x)(m)(abandonment).doc P8735 MAR-19-2089 16:24 AHCA Mar 19 2009 1699 tisks associated with leaving the treatment unfinished and the dentist should make any appropriate referrals for finalization of the treatment. Finally, a dentist shall not begin treatment on a patient with knowledge that he will not be able to finish the treatment without informing and obtaining the patient's consent and making arrangement for continued treatment. Further, the prevailing standard of care requires that a dentist provide for emergency 24-hour treatment for all patients s/he is treating as solidified in Florida Administrative Code Rule 64B5-17.004. , COUNT ONE: STANDARD OF CARE 21. Petitioner realleges and incorporates paragraphs one (1) through twenty (20) as if fully set forth herein. 22. Section 466.028(1)(x), Florida Statutes (2006), provides that being guilty of incompetence or negligence by failing to meet the minimum standards of performance in diagnosis and treatment when measured against generally prevailing peer performance, induding, but not limited to, the undertaking of diagnosis and treatment for which the dentist is not qualified by training or experience or being guilty of dental malpractice constitutes grounds for disciplinary action by the Board of Dentistry, 23. Respondent was negligent and failed to meet the minimum standards of dental performance in one or more of the following ways: -B- 7:APSU\Medical\ benustry\David Flynn\aamin Complaints\AC's 1 OSEPOR\Mamsa(x)(m)(abandanment).doc P9735 MAR-19-2089 16:21 a) b) ¢) M. . PHA lar 19 2009 16:39 By failing, on or about January 15, 2007, to perform a comprehensive intra-oral and extra-oral examination of patient L.S., to include, but not limited to, failing to perform a comprehensive periodontal examination with periodontal pocket depth probing and charting and/or by failing to perform an adequate comprehensive radiographic examination which reflected all teeth present and/or which reflects the entire jawbone where a full-denture is treatment planned and/or by failing to accurately chart Patient L.S.’s dentition, which reflects all oral pathology or lack thereof and/or by beginning restorative dentistry without treating Patient L.S.’s noted lower periodontal pathology or referring Patient L.S. for periodontal therapy; By failing, on or January 15, 2007, and/or January 23, 2007, to inform Patient L.S. that he would not be able to continue treatment of Patient L.S. in order to obtain informed consent to the treatment and/or by failing to arrange for continued treatment of Patient L.S.; and/or By unilaterally abandoning, after on or about January 23, 2007, the treatment of Patient L.S. and/or by failing to arrange for 24-hour emergency treatment for Patient L.S. and/or by failing to arrange for any continued treatment of Patient L.S. 24, Based on the foregoing, the Respondent has violated Section 466.028(1)(x), Florida Statutes (2006), by being guilty of incompetence or negligence by failing to meet the minimum standards of performance in diagnosis and treatment when measured against generally prevailing peer performance, including, but not limited to, the undertaking of diagnosis and treatment for which the dentist is not qualified by training or experience or being guilty of dental malpractice. - 9 . J:\PSU\Madical\Dentstry\David Flynn\Admin Complaints\AC's 9SEPOB\Mamsa(x}(m) abandonment) .dac P.1@/35 MWOR-19-2009 16:21 auca Mar 19 2009 16:33 COUNT TWO: DEFICIENT RECORDS 25. Petitioner realleges and incorporates paragraphs one (1) through twenty (20) as if fully set forth herein. 26. Section 466.028(1)(m), Florida Statutes (2006), provides that failing to keep written dental records and medical history records justifying the course of treatment of the patient including, but not limited to, patient histories, examination results, test rasults, and X rays, if taken, constitutes grounds for discipline by the Board of Dentistry. 27. For purposes of implementing Section 466.028(1)(m), Rule 64B5-17.002, Florida Administrative Code, requires that a dentist shall maintain written records on each patient which shall contain, at a minimum, appropriate medical history; results of clinical examination and tests conducted including the identification, or lack thereof, of any oral pathology or diseases; any radiographs used for the diagnosis or treatment of the patient; treatment plan proposed by the dentist, and treatment rendered to the patient. 28. Respondent failed to keep written dental records and medical history records justifying the course of treatment in one or more of the following ways: a) By failing, on or about January 15, 2007, through January 23, 2007, to accurately chart Patient L.S’ s dentition to include, but not limited to caries charting, oral pathology -10- J:\PSU\Medical\Dentistry\David Flynn\admin Complaints\AC's 19SEP08\Mamea(x)(m)(abandonment).doc P.11/35 MAR-19-2089 16:22 b) c) d) Mar 19 2 : pHCA oos = 16:40 charting, existing restoration charting, proposed restoration charting, and/or proposed restoration charting that was accomplished.; By failing, on or about January 15, 2007, to document all examination(s)/test(s) performed and the results thereof to include, but not limited to, periodontal probing results and/or tooth mobility results, if so performed; By failing, on or about January 15, 2007, to document the examination performed to justify the extractions of teeth numbers 22 and 26/27; By failing, on or about January 15, 2007, to proceed with the lower restoration of Patient L.S.s partial denture without noting a clinical justification for failing to perform periodontal therapy first to justify the sequence of restoration of Patient L.S/s dentition; e) f) g) By failing, on or about January 23, 2007, to document the amount and type of anesthetic used during extractions; By failing, on or about January 23, 2007, to document any adjustments made to the acrylic partial denture, if so done, and/or By failing to document in Patient L.S/s file the necessity for discontinuing treatment of Patient L.S. and any discussion that may have occurred regarding his inability to continue treatment of Patient L.S. and/or by failing to document the dentist who was to continue treatment of Patient LS. in his absence. 29. Based on the foregoing, Respondent has violated Section 466.028(1)(m), Florida Statutes (2006) by failing to keep written dental records and medical history records justifying the course of treatment of li- J:\PSU\Medical\Dentistry\David Flyan\Admin Complaints\AC's 19SEPOB\Mamsa(x)(m)(abandonment).doc P1235 MAR-19-2en8 16:29 ace Mar 19 2009 16:40 P.13/35 the patient including, but not limited to, patient histories, examination results, test results, and X rays, if taken. WHEREFORE, the Petitioner respectfully requests that the Board of Dentistry enter an order imposing one or more of the following penalties: revocation or suspension of the Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. ' SIGNED this 19" day of September, 2008. Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General Be Db, £. EE: eo David D. ym Ic | Lan ssistant General Counse! DEPARTMENT OF HEATH DOH Prosecution Services Unit SLERK. FSC pe 4052 Bald Cypress Way, Bin C-65 ~27x(8 Tallahassee, Florida 32399-3265 Florida Bar # 759511 850.245.4640 850.245.4683 FAX PCP: aha/e & PCP members: C77, wR 7M DOH vs. EBRAHIM MAMSA, 0.D.S., Case No, 2007-14963 . 12 - J:\PSU\Medical\Denbstry\Devid Flynn\Admin Complainss\AC's 19SEP08\Mamea(x)(m)(abandonment).doc Mar 19 20 : MAR-19-2889 16:22 AHCA 08 Te: NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 420.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution ofa disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed. DOH vs. EBRAHIM MAMSA, D.D.S., Case No. 2007-14963 . L .- 3:\PSU\Madical\Dentistry\Dawid Fiynn\Admin Complaints\AC's 19SEPO8\Mamsa(x)(m)(abandonment).dac P.14/35

Docket for Case No: 09-001509PL