STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, vs. CASE NUMBER: 2008-19142 CHARLES STAMITOLES, D.D.S., RESPONDENT, f ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the , Board of Dentistry against the Respondent, Charles Stamitoles, D.D.S., and in support thereof alleges: 1. Petitioner is the state department charged with regulating 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 a licensed dentist within the State of Florida, having been issued license number DN 10168. Filed December 15, 2011 9:32 AM Division of Administrative Hearings 3. Respondent's current address of record is 1025 Creighton Road, Pensacola, Florida 32504. 4. The Respondent provided dental care and treatment to Patient M.L., an 82 year old female, from on or about June 6, 2005, through on or about October 17, 2007. Patient M.L. first presented to Respondent on or about June 6, 2005, with a broken tooth number 8. Respondent performed a limited exam and took a periapical x-ray. ut Oo = Q cs fu ao 2 3 hos Respondent's office for a comprehensive exam and full mouth x-rays. Respondent's treatment notes for the June 27, 2005 visit record “Perio Recommended—STM (soft tissue management)” note that Patient M.L. broke tooth number 17 at Red Lobster and conclude with “she is not concerned about the fact that the mand anterior crowns (lower front crowns existing at teeth numbers 23-26) are ground down to the metal— probe today.” Respondent failed to justify his recommendation for perio- STM as written in the treatment note, with either a diagnosis and/or exam result. 6. During the Respondent’s exam and diagnosis of Patient M.L. on or about June 27, 2005, radiographs were taken, but Respondent failed to 2 JAPSU\Medical\wayne mitchell\!-09f DntlAC's\StamitolesO 8-19 142(m)(x)(t)erwnbrdgfraud.nowrk.doc fully examine and document the general condition of Patient M.L.’s teeth, gums and mouth. There is no documentation of periodontal depth probe, and/or of tooth charting, or of the results of Respondent’s purported comprehensive exam of Patient M.L. Respondent billed Patient M.L. for a comprehensive exam, but woefully failed to fully diagnose overall conditions present in Patient M.L.’s mouth and/or record the results of the exam, and failed to formulate and record an appropriate comprehensive treatment plan for Patient MLL. 7. Respondent apparently presented a limited treatment plan for teeth numbers 5, 20, 29 and 17, consisting of post/core build ups and PFM crowns at teeth numbers 5 and 20, to place a composite restoration at tooth number 17, and to watch the bridge existing at teeth sites 29-31. A later notation to the June 27, 2005, treatment plan notes include prep and placement of PFM crowns at teeth sites 23-26. Respondent failed to perform and/or provide a diagnosis to support the written treatment plans, and there is no record of alternate treatment options with risks/benefits of each explained to the patient. 3 JAPSU\Medical\wayne mitchell\] -09f. DntlAC's\StamitolesO8-19142(m)(x)(t)erwnbrdgfraud.-nowrk.doc Failure to Treat or Refer for Perio Condition 8. Respondent during his entire course of treatment failed to adequately diagnose, treat or refer Patient M.L. for treatment of existing periodontal pathology prior to embarking upon any of his restorative treatment regimens. 9, There is evidence that Patient M.L. presented with periodontal problems when she was first seen by Respondent. As noted above, Resnondent's treatment note for June 27, 2005, cites “Perio recommended ~ STM.” Nothing else is recorded about the periodontium while this terse note indicates that there was some level of periodontal disease or pathology present and observed on June 27, 2005. Respondent failed to perform and/or failed to record the results of a complete periodontal examination of Patient M.L., including periodontal pocket depth charting. 10. A patient presenting with periodontal disease can have either “gingivitis” or “periodontitis.” Periodontal disease can be both acute (gingivitis) and/or chronic (periodontitis), and can affect both the gingiva (the gums) around the teeth and the supporting bone around the teeth (alveolar bone). Gingivitis, which typically involves only the gingiva, causes the gingiva to typically become puffy, red, inflamed and to bleed easily. 4 JAPSU\Medical\wayne mitchell\} -09f. DntlAC's\StamitolesO 8-19 142(m)(x)(verwnbrdgfraud nowrk.doc Gingivitis is treatable, but left untreated, it can advance to periodontitis, which causes the loss of the supporting alveolar bone that surrounds each tooth root, while it simultaneously leads to increased periodontal pocket depths. 11. A periodontal pocket is the distance that is measured from the height of the marginal gingiva that surrounds a tooth to the lower level attachment of the gingiva to the cementum of the tooth root. Periodontal surfaces on the front (facial or buccal) of a tooth and three surfaces on the back (lingual) of a tooth — for a total of six periodontal pocket depth measurements for each tooth. 12. A patient with pocket depths of no more than 3-4 millimeters should be monitored and advised by a treating dentist that he/she should be able to clean out intra-oral bacteria to the depths of those periodontal pockets using good oral hygiene — tooth brushing and flossing. A patient with pocket depths of greater than 3-4 mm, especially 5-8 mm or more, would not be able to self-clean to those increased periodontal pocket depths and the incipient bacteria therein would continue to release toxins 5 JAPSU\Medical\wayne mitcheli\1-09f.DntiAC's\StamitolesO 8-19 142(m)(x)(t)erwnbrdgfraud.nowrk.doc and most likely cause the continuance and/or advancement of chronic periodontitis. 13. A patient with pocket depths of greater than 3-4 mm generally has more advanced periodontal disease that is affecting both the gingiva around the teeth, and the level of the attachment of the gingiva to the cementum of each affected tooth root (the periodontal pocket depth) and likely is experiencing ongoing resorption of the alveolar bone that support the teeth. 14. As part of a patient's initial comprehensive oral examination, a dentist should perform a comprehensive periodontal examination, including diagnosis of the condition of the gingiva, tooth mobility testing and full- mouth periodontal pocket depth probing. These diagnoses should be fully and accurately recorded in treatment notes and/or charted when the exam is performed, and updated regularly on periodontal depth probe teeth charts. 15. A dentist should also correlate periodontal pocket depth findings with a careful review of diagnostic x-rays to determine if there is any bone loss around teeth where pocketing is noted. If the periodontal pocket depths are greater that 3-4 millimeters and the x-rays show loss of 6 JAPSU\Medicaliwayne mitchel]\! -09f. DntlAC's\Stam itolesO8-19142(m)(x)(therwnbrdgfraud.nowrk.doc periodontal bone, a dentist should immediately and adequately diagnose the severity of the patient's periodontal condition, fully inform the patient, - and develop an effective treatment plan to treat the periodontal disease. This should include expeditiously providing appropriate clinical treatments, instruction on home hygiene to enhance the patient’s periodontal health, regular monitoring and cleanings with notations re: the periodontal condition, and/or referral to a specialist for appropriate treatment before performing further restorative treatment in the patient's mouth. Respondent failed to meet any of these standards, from the initial visit of Patient M.L. forward. 16. Despite writing on June 27, 2005, that the patient needed some sort of periodontal therapy (STM-soft tissue management) there is no indication that the periodontium was ever treated by Respondent or that Patient M.L. was referred to a specialist for periodontal treatment. The Respondent treatment planned and performed multiple crown and fixed prosthetic treatments without adequately diagnosing, treating, and/or referring Patient M.L. to a specialist for adequate treatment of the existing periodontal pathology prior to embarking upon a two year restorative course of treatment. 7 JAPSU\Medicalhwayne mitchell\! -09f. DntlA C's\StamitalesO 8-19 | 42(m)(x)(therwnbrdgfraud.nowrk.doc 17. Notwithstanding Respondent's inadequate comprehensive perio exam diagnoses, Patient M.L. presented to Respondent for several years with sustained and worsening periodontal pathology. A comprehensive periodontal treatment plan was never recommended by Respondent and fully explained to Patient M.L. during his course of treatment, nor did Respondent ever note a proactive referral of Patient M.L. to a periodontist for treatment of sustained periodontal pathology prior to continuing with his restorative course of dental treatment. i8. The prevailing standard of care requires a dentist to timely determine and/or diagnose, if a patient presents with any compromised periodontal pathology, and to treatment plan, then treat such pathology before embarking upon other restorative treatments in a patient's mouth. If sustainecl treatment by the dentist fails to ameliorate or cure the pathology, the dentist should refer the patient to a periodontist within a reasonable time before proceeding with further restorative treatments. Respondent failed to meet this standard by failing to adequately diagnose, and/or treat Patient M.L’s periodontal pathology, while embarking upon multiple restorative treatments in Patient M.L.’s mouth without referring Patient M.L. to a periodontist for resolution of the periodontal! pathology. 8 JAPSU\Medical\wayne mitchell\ | -09f. DntlAC's\StamitoiesO8-19 142(m)(x)(t}erwnbrdgfraud.nowrk.doc 19. Based on post-operative radiographs taken by a subsequent treater (Exhibit 1A, Page 90 Large Envelope) as well as on a clinical exam performed in March 2009, it is dear that Patient M.L. had periodontal problems of various degrees in October 2007 when Respondent performed multiple crown and bridge treatments on her. A post-operative full mouth x- ray (FMX) taken November 21, 2007, reveals some bone loss in all four quacirants on Patient M.L., particularly at teeth numbers 5, 7, 10, 19, 30 and 31. A clinical exam conducted on or about March 31, 2009, by a department retained expert, also revealed moderate to heavy bleeding in all four quadrants, with pockets of 4 to 6mm. Subsequent Restorative Treatment 20. On or about August 23, 2005, Patient M.L. returned to the Respondent's office. Respondent’s progress note records that an occlusal facial (OF) restoration was placed, along with an indirect pulp cap on tooth number 17. This entry concludes with “Patient did great, if she has any more problems we will ext it.” Nothing was recorded regarding the anesthetic used, the type of restoration material used and/or the reason a restoration was indicated. 21. On or about January 5, 2006, Patient M.L. presented to Respondent for a periodic oral exam. Respondent’s treatment notes for 9 JAPSU\Medical\wayne mitchell\1-09F. DntlAC's\StamitolesO8 -19142(m)(x)(therwnbrdgfraud .nowrk.doc that visit do not contain any findings or results of that exam, except a terse note that “#31? Maybe looser.” A limited treatment plan was apparently generated during this visit to place restorations at teeth numbers 2-3, and for build ups and seating of PFM. crowns at teeth numbers 4-5. The Respondent failed to perform or provide a diagnosis or radiographic findings to support any of these treatments. There was no updated periodontal charting, and there was no written justification for this 22, On or about January 9, 2006, Respondent commenced with treatment of the four teeth (#’s 2, 3, 4 and 5). Respondent failed to record the type of restoration material used, and/or the type and amount of anesthetic used. Teeth numbers 2 and 3 had indirect pulp caps placed along with composites. Teeth numbers 4 and 5 were recorded as being built up/prepped for crowns, along with a pulp cap on tooth number 5. There was no recorded diagnosis anywhere in the chart to justify any of the treatment performed on these teeth. Respondent’s treatment notes for a follow-up visit on January 25, 2006, indicate that the final PFM crowns were delivered that day, but Respondent failed to record the type cement used and/or if the final fit was checked for marginal integrity. 10 JAPSU\Medical\wayne mitchell\! -09f. DntlAC's\Stamitoles0 8-19 142(m)(x)(therwnbrdgfraud nowrk.doc 23. On or about October 30, 2006, Patient M.L. presented again to Respondent for a limited oral exam. Respondent's treatment notes for that visit do not contain any findings or results of that exam, except a terse note that a PA x-ray was taken of teeth numbers 28-29-30, and next visit root canal therapy would commence on tooth number 29, tooth number 17 would be extracted, and a post and core done. Respondent apparently formulated a treatment plan for root canal therapy, and cast post/core with M.L. was billed for in December 2006. There is no diagnosis or exam results recorded to justify any of these proposed treatments. 24, On or about November 14, 2006, Patient M.L. returned to Respondent's office after a crown at tooth number 8 came off. During that visit Respondent treatment planned, and performed a_ previously unscheduleci root canal therapy on tooth number 8. Respondent failed to note any diagnosis or exam results to justify this root canal therapy, including, thermal sensitivity, percussion and/or radiographic exam. Respondent failed to note any post-op exam regarding length of the fill, and/or fill material used in which canal(s). in JAPSU\Medicaliwayne mitchell\} -09f, DntlAC's\Stam itoles08- 19 142(m)(x)(t}erwnbrdefraud nowrk.doc Improper Upcoding 25. On or about November 15, 2006, Patient M.L. returned to the Respondent's office. Respondent's progress notes for this visit read “Cast Post_and Core, Dr. Prep tooth # 8 etch tenure A&B (red post) Geristore amount, patient pre-med today”. The note reflects that Respondent performed a cast post and core at tooth number 8 during this visit and the patient was billed for a cast post and core. An impression for a new PFM 26. A “cast post and core” is billed and coded as a higher charge than a prefabricated post. A subsequent radiograph taken by the Respondent (disc labeled picture # “49.TIF) shows a serrated prefabricated post was placed at tooth number 8. Two different radiographs (Panorex Exhibit 7, Page 113 Case File envelope)(FMX Exhibit 1A, Page 90 Case File envelope) taken by two subsequent treating dentists also reveal that the post placed by Respondent in tooth number 8 is a serrated prefabricated post. 27. Respondent failed to perform and/or record, delivery and seating of the final PFM crown for tooth number &, as it is nowhere described in the November 2006 treatment notes for Patient M.L. 12 JAPSU\Medical\wayne mitchell\1-09f. DntlAC's\StamitolesO 8-19 142(m)(x)(t)erwnbrdgfraud.nowrk.doc Respondent's billing ledger shows Patient M.L.’s account billed for the final PFM crown on or about November 29, 2006, but there is-no visit recorded to that effect in the treatment notes reflecting that final delivery of the PFM crown at tooth number 8 was performed as charged by Respondent. Other Billed Procedures Never Provided 28. On or about December 14, 2006, Patient M.L. returned to the Respondent's office, ostensibly for a limited exam. Respondent failed to Respondent apparently performed root canal therapy that day for tooth number 29, which was previously treatment planned on or about October 30, 2006. There were no diagnosis or exam results recorded to justify any of the treatrnent performed on tooth number 29. 29. During the December 14, 2006 visit, Respondent formulated a proposed treatment pian without any justification from exam results and/or the treatment records to place a cast post and core and seat a PFM crown at tooth nurnber 29. Respondent also proposed to place pulp caps, crown build ups and seat PFM crowns at teeth numbers 31-32, then to seat a new four unit bridge between teeth numbers 29 to 32 in the lower right quadrant of Patient M.L.’s mouth. In fact, this four-unit bridge was billed 13 JA\PSU\Medical\wayne mitchell\1-09f. DntlAC's\StamitolesO 8-191 42(m)(x)(erwnbrdgfraud.nowrk.doc for by Respondent on this day, as noted in the financial ledger for that day of service. Respondent never fabricated or delivered the lower four-unit bridge to Patient M.L. Moreover, Respondent’s progress notes for Patient M.L. do not record that any aspect of this bridge was performed between December 14, 2006, and October 5, 2007. The patient was billed for another bridge between teeth numbers 28 to 32 in this exact same area on or about October 5, 2007, (see below, par. 38). The patient never 30. On or about December 18, 2006, Respondent performed a previously unscheduled root canal on Patient M.L.’s tooth number 28. Respondent failed to provide or record any diagnosis or exam results to justify any of this treatment on tooth number 28. On or about April 25, 2007, Patient M.L. returned to the Respondent, who recorded in the treatment note for that visit that he placed a “Cast Post and Core” for teeth numbers 28 and 29. Patient M.L. was charged by Respondent for the cast post and core at tooth number 28 accordingly, which is charged at a higher rate than use of prefabricated post/cores. This was clearly reflected in the Respondent's financial ledger for this visit. (Page 260 Case File). A subsequent radiograph taken by the Respondent (disc labeled 14 JAPSU\Medical\wayne mitchell\} -09f. DntiAC's\StamitolesO8-19 142(m)(x)(t)erwnbrdg fraud nowrk.doc picture # “ 51TIF) shows a serrated prefabricated post was placed at tooth number 28. Two different radiographs (Panorex Exhibit 7, Page 113 Case “File envelope)(FMX Exhibit 1A, Page 90 Case File envelope) taken by two subsequent treating dentists also reveal that the post placed by Respondent in tooth number 28 is a serrated prefabricated post. 31. On or about June 13, 2007, Patient M.L. returned to Respondent, who then extracted tooth number 17, Respondent failed to extraction of tooth number 17 at this visit. 32. On or about October 5, 2007, Patient M.L. returned to Respondent who recorded in his treatment notes that-he performed pulp cap, build ups and contouring for crown prep/placement at tooth numbers 7 and 10. Respondent's progress notes for this day also record that: “#28 to 32, prepped #28, 31 32 abutments #29 30 ponitcs”. There is no evidence that any crown preparations were ever done by Respondent on teeth numbers 7, 10, 23, 24, 25, or 26, as reflected on two post-operative radiographs taken by two subsequent treating dentists. 33. Respondent's billing ledger for the October 5, 2007, visit clearly shows he charged Patient M.L. for pulp caps, crown build ups, and 15 JAPSU\Medical\wayne mitchell\!-09f.DntlAC's\Stamitoles08-19 142(m)(x)(therwnbrdgfraud nowrk.doc temporary and permanent crowns at teeth numbers 7-10. Subsequent treater radiographs and a subsequent clinical exam indicated that crown prep, build ups and crowns were never done at teeth numbers, 7, 9 and/or 10 as falsely recorded and billed by Respondent. Moreover, Patient M.L.’s tooth number 8 had purportedly previously been crowned by Respondent in November 2006 (paragraph 25 above) according to his billing financial ledger records (November 14-29, 2006 for crown build ups, prep, temporary and PFM crown delivery at tooth number 8). This crown was still present in subsequent treater radiographs and present at the clinical examination of Patient M.L. on March 31, 2009. However, the Respondent falsely recorded that he provided and/or billed the patient for a new crown at tooth number 8 about a year iater, on or about October 5, 2007. 34, The same progress note entry for October 5, 2007, records that the following eight procedures were performed by Respondent on four teeth that could not possibly have been done. Respondent recorded that he did a “pulp cap” (PC) and a buildup (BU) on all four lower incisors: “#23 “PC BU” , #24 “PC BU”, #25 “PC BU”, #26 “PC BU.” Patient M.L.’s account was charged accordingly, along with charges for fabrication/seating of both temporary and permanent PFM crowns at each 16 JAPSU\Medical\wayne mitchell\! -09f. DntlA C's\StamitolesO8- 19142(m)(x)Herwnbrdgfraud. nowrk.doc of those teeth, as well as charges for new PFM crowns at teeth numbers 29-32. 35. Based upon subsequent treaters’ x-rays, and upon a subsequent clinical exam of Patient M.L. performed on or about March 31, 2009, by an agency expert, it was determined that each of the four incisors (teeth numbers 23-26) had the original permanent crowns present that were present when Dr. Stamitoles first examined Patient M.L on June 7, 2005. 36. In order to do the procedures that Respondent recorded he did (and billed for) at teeth numbers 23-26 on October 5, 2007, it would have required that the existing permanent crowns be removed. There was no sign that these crowns had ever been removed from teeth numbers 23-26 by Respondent during any of his course of treatment for Patient M.L. Respondent fraudulently recorded and stated that he provided this treatment, and billed for treatment never performed. 37. Moreover, a four-unit bridge, including PFM crowns, spanning from teeth numbers 28 to 31 was again billed for by Respondent on October 5, 2007. Respondent’s progress notes for this visit record that: “#28 to 32, prepped #28, 31 32 abutments #29 30 ponitcs”. This is the 17 J:\PSU\Medical\wayne mitchell\!-O9f DntlAC's\StamitolesO8- 191 42(m)(x)(therwnbrdgfraud.nowrk.doc same area that Respondent had billed Patient M.L. for on or about December 14, 2006, for the same type bridge which Respondent never fabricated and/or delivered (see paragraph 29 above). 38. In October 2007, Patient M.L. was again billed for and paid for a bridge that was never completed. Upon subsequent clinical examination on or about March 31, 2009, it was determined that Patient M.L. never received the twice billed for bridge at teeth numbers 28-32, as falsely recorded and/or billed by Respondent both in December 2006 and again in October 2007. 39. Patient M.L.’s final visit to Respondent was on or about October 17, 2007, when Respondent recorded simply that he extracted tooth number 29 root tip and remade temporary crowns at teeth numbers 28-32. Respondent failed to provide and/or record a diagnosis with exam results to support this extraction procedure. Respondent failed to record the type/amount of anesthesia used during this procedure. Respondent also failed to provide an adequate treatment plan to support this procedure with consent provided by the patient prior to extraction of the tooth. 40. Respondent during his course of treatment noted in treatment notes for virtually every vital tooth that he was restoring that indirect pulp 18 JAPSU\Medical\wayne mitchell\1-09f, DntiAC's\StamitolesO8~ 19 142(m)(x)()crwnbrdgfraud.nowrk.doc caps were being placed. It is very unusual for a patient in their 80's to have a pulp that would be so close to the surface that an Indirect Pulp cap would be needed on every tooth that was prepped for crowns/restoration. 41. Particularly regarding Patient M.L.’s tooth number 3: a review of two post-operative bitewing radiographs taken by a subsequent treater revealed a receded pulp and a restoration that is very shallow. The pulp and the restoration are over 3mm apart. Thus, an Indirect Pulp cap would ed in restoring this tooth. Respondent recorded in the January 9, 2006, treatment note that he placed a pulp cap on tooth number three regardless. Performing an indirect pulp cap without medical necessity is practicing below a minimum standard of care. Disputed Treatment/Charges for Treatment 42. On or about December 4,. 2007, Patient M.L. by and through her daughter disputed charges for treatment submitted by Respondent to Patient M.L.’s dental Care Credit financing account. Respondent was asked by Patient M.L. to fully refund those amounts billed for which were never done and/or for thase services which were improperly billed twice, as described above. Formal written dispute was subsequently submitted to the Care Credit program. 19 J:\PSU\Medical\wayne mitchell\1 -09f. DntlAC's\Stamitoles08-19142(m)(x)(t)erwnbrdgfraud nowrk.doc 43. On or about January 7, 2008, Respondent wrote back to Patient M.L. and her daughter, D.P., refusing any refunds and claiming the following: “As for refunding her money, most of the preparation work has been completed and all that remains is impressions. I would recommend that she come and complete her treatment.” 44. In or about March, 2008, Respondent received a letter from Care Credit informing him that the October 5, 2007, charges for $6900 Services” and requesting response to the allegations. Respondent submitted a written response dated March 18, 2008, to Care Credit claiming inter alia., “90% work completed” Not our fault she couldn’t return. Offered to go to Nursing Home. Did not impress, tissues were not healthy. Waiting for them to get healthy.” In a subsequent letter dated March 19, 2008, Respondent wrote to Cardholder Disputes Department, “...we have completed 90% of the work and have made repeated attempts to complete her restorations...”. 45. On or about August 14, 2008, Patient M.L. filed this complaint with the department, by and through her adult daughter, D.P. On or about November 24, 2008, Respondent submitted a letter to a Department investigator again claiming that: “all dental work had been completed 20 JAPSU\Medical\wayne mitchell\|-09f. nti AC's\StamitolesO 8-19 142(m)(x)(ticrwnbrdgfraud nowrk.doc 90%” “it is our office policy that all work is paid in full before crown and bridge can be cemented, but that on this case M.L. paid ahead of time with her Care Credit so she could get 0% interest”. 46. In sum, Respondent made at least three different official misrepresentations that most of the dental treatment that he had charged Patient M.L. for and that she had paid for, had been completed: e Ina January 7, 2008, letter to patient’s daughter, D.P., advising her that “most of the preparation work has been completed and all that remains is impressions.” ¢ Ina March 18, and 19, 2008, response letter to Care Credit claiming “90% work completed.” e In a November 24, 2008, response letter to a Department investigator, claiming that: “all dental work had been completed 90%” “it is our office policy that all work is paid in full before crown and bridge can be cemented, but that on this case M.L. paid ahead of time with her Care Credit so she could get 0% interest.” 47, The prevailing standard of dental care in performing crown/bridge treatment, and other restorative procedures, including root canal therapy, requires a dentist to fully diagnose conditions in a patient's mouth requiring such treatment(s) as based upon clinical exam results, including x-rays, and to fully document the diagnoses in the treatment records to support any proposed treatment. It is then incumbent upon a treating dentist to explain diagnoses and exam results to a patient, and to 2] JAPSU\Medical\wayne mitchell\]-09f. DntiAC’s\Stamitoles08-19 142(m)(x)(t)crwnbrdgfraud.nowrk.doc formulate and record appropriate treatment plans, to present all proposed treatment pians along with treatment alternatives, including explanation of risks/benefits to a patient, and then to obtain informed consent from the patient. The Respondent failed to meet these standards. 48. The Respondent's treatment records failed to justify the course of treatment for Patient M.L. in that Respondent failed to provide complete documentation of his exam results including diagnoses and x-rays to support treatments provided; and failed to fully document the general condition of Patient M.L.’s teeth, gums and mouth, including periodontal pathology requiring treatment, before proceeding with multiple crown/bridge restorations. Respondent further failed to document in the treatment records the conditions necessitating the range of treatments provided. COUNT E-Recordkeeping 49, Petitioner re-alleges the allegations contained in paragraphs one (1) through forty-nine (49) as if fully incorporated herein. 50. Section 466.028(1)(m), Florida Statutes (2004-2007), as implemented by Rule 64B5-17.002, Florida Administrative Code (F.A.C.), states that failing to keep written dental records and medical history records 22 JAPSU\Medical\wayne mitchell\] -09f DntlA C's\StamitolesO8- 19] 42(m)(x)(tierwnbrdgfraud nowrk.doc justifying the course of treatment of the patient including, but not limited to, patient histories, examination results, test results, and x-rays if taken, shall constitute grounds for disciplinary action by the Board of Dentistry. 51. Respondent's dental records for Patient M.L. failed to justify the course of Patient M.L.’s treatment in one or more of the following ways: a) The Respondent did not record the outcome of his purported comprehensive exam on or about June 27, 2005, including exam results, finding of diagnostic x-rays, including fully documenting the general condition of Patient M.L.‘s teeth, gums and mouth prior to proceeding with crown bridge/restorations; b) Respondent billed Patient M.L. for a comprehensive exam, but woefully failed to fully diagnose overall conditions present in Patient M.L.’s mouth and/or record the results of the exam, and failed to formulate and record an appropriate comprehensive treatment plan for Patient M.L. during the June 27, 2005, exam visit; c) The Respondent also failed to document performing any periodontal depth probe charting, and/or tooth charting, and/or any adequate results of Respondent’s purported comprehensive exam of Patient M.L. at any time during his course of treatment; d) The Respondent failed to perform and/or record an adequate diagnosis to support the written treatment plan(s) initially formulated October 27, 2005, and there is no record of alternate treatment options with risks/benefits of each explained to the patient; e) The Respondent failed to perform and/or failed to record the results of a complete periodontal examination of Patient 23 J:\PSU\Medical\wayne mitchell\!-09f. DntlAC's\Stamitoles08- 19 142(m)(x)(t)crwnbrdgfraud.nowrk.doc M.L., including periodontal pocket depth charting to support his treatment note for June 27, 2005, which cites “Perio recommended — STM”: f) Respondent failed to record an appropriate treatment regimen for the evident periodontal pathology noted in Patient M.L.’s mouth on June 27, 2005, prior to embarking upon his restorative course of treatment, and/or failed to note why he did not treat this pathology or refer Patient M.L. to a specialist; g) Respondent failed to record in August 23, 2005, treatment notes why a restoration and pulp cap was indicated for tooth number 17, the amount/type of anesthetic used, and/or the type of restoration material used; h) Respondent failed to document any findings or results of a periodic exam performed January 5, 2006, except a terse note that “#31? Maybe looser.” A limited treatment plan was apparently generated during this visit to place restorations at teeth numbers 2-3, and for build ups and seating of PFM crowns at teeth numbers 4-5. The Respondent failed to perform or document a diagnosis or radiographic findings to support any of these treatments. There was no updated periodontal charting, and there was no written justification for this treatment plan; i) Respondent failed to record the restoration material, type/amount of anesthetic and why pulp caps/crowns were indicated during treatment for teeth numbers 2-5 on January 9 and 25, 2006. Respondent also failed to note the type cement used and if final crown fits were checked properly for marginal integrity; j) Respondent's treatment notes for an October 30, 2006, oral exam do not contain any findings or results of that exam, except a terse note that a PA x-ray was taken of teeth numbers 28-29-30, and next visit root canal therapy would 24 JAPSU\Medical\wayne mitchell\!-09f DntlAC's\StamitolesO 8-19 142(m)(x)(therwnbrdgfraud nowrk.doc commence on tooth number 29, tooth number 17 would be extracted, and a post and core done. There is no diagnosis or exam results recorded to justify any of these proposed treatments; I) Respondent failed to note any diagnosis or exam results to justify a previously unscheduled root canal on tooth number 8 during a November 14, 2006 visit, including thermal sensitivity, percussion and/or radiographic exam. Respondent failed to note any post-op exam regarding length of the fill, and/or fill material used in which canals); 1) Respondent failed to perform and/or record, delivery and seating of the final PFM crown for tooth number 8, as it is nowhere described in the November 2006 treatment notes for Patient M.L. Respondent's billing ledger shows Patient M.L.’s account billed for the final PFM crown on or about November 29, 2006, but there is no visit recorded to that effect in the treatment notes reflecting that final delivery of the PFM crown at tooth number 8 was performed as charged by Respondent; m) Respondent falsely recorded in treatment notes, and in billing documents for a November 16, 2006, visit that he performed a cast post and core at tooth number 8 of Patient M.L., and failed to accurately note he actually placed a serrated prefabricated post at tooth number 8; n) Respondent failed to note any diagnosis or exam results of an exam visit on December 16, 2006, and/or failed to justify a previously unscheduled root canal on tooth number 29 during the November 14, 2006 visit, including thermal sensitivity, percussion and/or radiographic exam. Respondent failed to note any post-op exam regarding length of the fill, and/or fill material used in which canal(s); 0) Respondent formulated a proposed treatment pian without any justification from recorded exam results and/or the 25 J:A\PSU\Medical\wayne mitchell\1-09f. DntlAC's\StamitolesO 8-19 142(m)(x)(t)erwnbrdgfraud.nowrk.doc treatment records during the December 14, 2006 visit, to place a cast post and core and seat a PFM crown at tooth number 29. Respondent also proposed to place pulp caps, crown build ups and seat PFM crowns at teeth numbers 31- 32, then to seat a new four-unit bridge between teeth numbers 29 to 32 in the lower right quadrant of Patient M.L.’s mouth; p) Respondent failed to document why Patient M.L. was falsely billed for the proposed lower right bridge twice, on or about December 14, 2006, and again on October 5, 2007, and the bridge was never fabricated or delivered by Respondent to the patient; Respondent failed to note any diagnosis or exam results of a visit on December 18, 2006, and/or failed to justify a previously unscheduled root canal on tooth number 28 during the December 18, 2006 visit, including thermal sensitivity, percussion and/or radiographic exam. Respondent failed to note any post-op exam regarding jength of the fill, and/or fill material used in which canail(s); r) Respondent falsely recorded in treatment notes, and in billing documents for an April 25, 2007, visit that he performed a cast post and core at tooth number 28 of Patient M.L., and failed to accurately note he actually placed a serrated prefabricated post at tooth number 28; s) Respondent failed to provide and/or record adequate exam results and diagnosis to justify the extraction of tooth number 17 during a June 13, 2007 visit; Respondent falsely recorded in treatment notes and charged falsely in billing documents for an October 5, 2007, visit that he performed pulp cap, build ups and/or crown preps and PFM crowns for teeth numbers 7-10 and 23-26, when Respondent knew or should have known that work was never provided; ot VS 26 J:\PSU\Medical\wayne mitchell\! -09f. DntiA C's\StamitolesO8-19 1 42(m )(x)(t)erwnbrdgfraud.nowrk.doc u) Respondent failed to document why Patient M.L. was falsely billed for a proposed lower right bridge (twice) again during, the October 5, 2007, visit when Respondent knew or should have known he never performed any such work at teeth sites 28-31. Respondent inaccurately noted again that he did perform crown/bridge work there during this visit when he did not; v) Respondent falsely recorded that he remade temporary crowns at teeth numbers 28-32 during Patient M.L.’s final visit October 17, 2007, when he knew or should have known he never did crown replacement/prep work there; and/or, w) Respondent failed to provide and/or record a diagnosis with exam results to support an extraction procedure on tooth number 29 “root tip” he noted performing October 17, 2007. Respondent failed to record the type/amount of anesthesia used during this procedure. Respondent also failed to provide an adequate treatment plan to support this procedure with consent provided by the patient prior to extraction of the tooth. 52. Based on the foregoing, the Respondent has violated Section 466.028(1)(m), Florida Statutes (2004-2007), by failing to keep written dental records justifying the course of treatment of the patient. COUNT Ii-Standard of Care 53. The Petitioner re-alleges the allegations contained in paragraphs one (1) through forty-nine (49) as if fully incorporated herein. 54. Section 466.028(1)(x), Florida Statutes (2004-2007), states that being guilty of incompetence or negligence by failing to meet the minimum 27 JAPSU\Medical\wayne mitchell\!-09£ DntlAC's\Stamitoles0 8-191 42(m)(x)(Qherwnbrdgfraud nowrk.doc 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, shall constitute grounds for disciplinary action by the Board of Dentistry. 55. The Respondent was negligent and failed to meet minimum standards of dental performance in diagnosing and treating Patient M.L. in a) The Respondent failed to provide a comprehensive diagnosis with adequate exam results including outcome of pre-op and post-op x-rays, with a comprehensive treatment plan when initiating and completing crown treatment in Patient M.L.'s mouth in 2004, 2005, 2006 and 2007; b) By failing to perform and/or document the results of a comprehensive diagnostic examination, including radiographs, of Patient M.L. when she presented as a new patient on or about June 5 and/or 27, 2005; C) By failing to perform a complete periodontal examination of Patient M.L., including periodontal pocket depth charting, when she presented as a new patient on or about June 5 and/or 27, 2005; d) By failing to perform and/or provide an adequate diagnosis to support treatment plan(s) initially formulated October 27, 2005, and there is no record of alternate treatment options with risks/benefits of each explained to the patient; e) The Respondent failed to perform and/or provide a complete periodontal examination of Patient M.L., including 28 J:\PSU\Medical\wayne mitchell\] -O9f. DntlAC's\Stamitoles08- 19 142(m)(x)(t)crwnbrdgfraud nowrk.doc periodontal pocket depth charting to support his treatment note for June 27, 2005, which cites “Perio recommended — STM"; f} Respondent failed to provide an appropriate treatment regimen for the evident periodontal pathology noted in Patient M.L.'s mouth on June 27, 2005, prior to embarking upon his restorative course of treatment, and/or failed to note why he did not treat this pathology or refer Patient M.L. to a specialist; g) Respondent failed to provide adequate diagnosis during an August 23, 2005, treatment exam why a restoration and pulp cap was indicated for tooth number 17; h) Respondent failed to perform or provide a diagnosis or radiographic findings to support any of the treatment plans proposed during a January 5, 2006, visit to place restorations at teeth numbers 2-3, and for build ups and seating of PFM crowns at teeth numbers 4-5; Respondent failed to perform or provide a diagnosis or radiographic findings to support why pulp caps/crowns were indicated during treatment for teeth numbers 2-5 on January 9 and 25, 2006. Respondent also failed to note the type cement used and if final crown fits were checked properly for marginal integrity; aes Respondent indicated in the January 9, 2006, treatment note that he placed a pulp cap on tooth number 3 when it was without medical necessity for that vital tooth; ~~ j k) Respondent failed to perform or provide adequate diagnosis or exam results to justify any of the proposed treatments during an October 30, 2006, exam visit for root canal therapy on tooth number 29, for tooth number 17 to be extracted, and a post and core done; 29 JAPSU\Medicaliwayne mitchell\}-09f. DntlAC's\StamitolesO 8-19 142(m)(x)(crwnbrdgfraud.nowrk.doc 1) Respondent failed to perform or provide any diagnosis or exam results to justify a previously unscheduled root canal on tooth number 8 during a November 14, 2006 visit, including thermal sensitivity, percussion and/or radiographic exam. Respondent failed to note any post-op exam regarding length of the fill, and/or fill material used in which canal(s); m)Respondent failed to perform and/or provide, delivery and seating of the final PFM crown for tooth number 8, as it is nowhere described in the November 2006 treatment notes for Patient M.L. Respondent's billing ledger shows Patient M.L.’S account billed for the final PFM crown on or about November 29, 2006, but there is no visit reflecting that final delivery of the PFM crown at tooth number 8 was performed as charged by Respondent; n) Respondent falsely indicated in treatment notes, and in billing documents for a November 16, 2006, visit that he performed a cast post and core at tooth number 8 of Patient M.L., and failed to accurately note he actually placed a serrated prefabricated post at tooth number 8; 0) Respondent failed to perform or provide any diagnosis or exam results of an exam visit on December 16, 2006, and/or failed to justify a previously unscheduled root canal on tooth number 29 during the November 14, 2006 visit, including thermal sensitivity, percussion and/or radiographic exam. Respondent failed to perform any post-op exam regarding length of the fill, and/or fill material used in which canal(s); p) Respondent formulated a proposed treatment plan without any justification from recorded exam results and/or the treatment records during the December 14, 2006 visit, to place a cast post and core and seat a PFM crown at tooth number 29. Respondent also proposed without adequate diagnosis to place pulp caps, crown build ups and seat PFM crowns at teeth numbers 31-32, then to seat a new four-unit 30 E:\PSU\Medical\wayne mitchell\!-09f. DntlAC’s\Stamitoles08-19142(m)(x)(t)erwnbrdgfraud nowrk.doc bridge between teeth numbers 29 to 32 in the lower right quadrant of Patient M.L.’s mouth; q) Respondent falsely billed Patient M.L. for a proposed lower right bridge twice, on or about December 14, 2006, and again on October 5, 2007, and the bridge was never fabricated or delivered by Respondent to the patient; r) Respondent failed to provide any diagnosis or exam results of a visit on December 18, 2006, and/or failed to justify a previously unscheduled root canal on tooth number 28 during the December 18, 2006 visit, including thermal sensitivity,. percussion and/or radiographic exam. Respondent failed to provide any post-op exam regarding length of the fill, and/or fill material used in which canai(s); s) Respondent falsely indicated in treatment notes, and in billing documents for an April 25, 2007, visit that he performed a cast post and core at tooth number 28 of Patient M.L., when he knew or should have known he actually placed a serrated prefabricated post at tooth number 28; t) Respondent failed to provide and/or perform adequate exam results and diagnosis to justify the extraction of tooth number 17 during a June 13, 2007 visit; u) Respondent falsely indicated and charged falsely that he performed pulp cap, build ups and/or crown preps.and PFM crowns for teeth numbers 7-10 and 23-26 during an October 5, 2007, visit, when Respondent knew or should have known that work was never provided; v) Respondent failed to accurately treat/bill Patient M.L. for a proposed lower right bridge (twice) again during, the October 5, 2007, visit when Respondent knew or should have known he never performed any such work at teeth sites 28-31. Respondent inaccurately noted again that he 31 TAPSU\Medical\wayne mitchell\!-09f. DntlAC's\Stamitoles08-19 142(m)(x)(t)erwnbrdgfraud .nowrk.doc 56. did perform crown/bridge work there during this visit when he did not; w) Respondent falsely indicated that he remade temporary crowns at teeth numbers 28-32 during Patient M.L.’s final visit October 17, 2007 when he knew or should have known he never did crown replacement/prep work there; and/or x) Respondent failed to provide and/or record a diagnosis with exam results to support an extraction procedure on tooth number 29 “root tip” he noted performing October 17, 2007. Respondent failed to record the type/amount of anesthesia used during this procedure. Respondent also failed to provide an adequate treatment plan to support this procedure with consent provided by the patient prior to extraction of the tooth. Based on the foregoing, the Respondent has violated Section 466.028(1)(x), Florida Statutes (2004-2007), 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. 57, COUNT IET: FRAUD, DECEIT, MISCONDUCT Petitioner realleges and incorporates paragraphs one (1) through forty-nine (49) as if fully set forth herein. 32 JAPSU\Medical\wayne mitchell\! -09f, DntlAC’s\Stamitoles0 8-19 142(m)(x)(t)crwnbrdgfraud.nowrk.doc 58. Section 466.028(1)(t), Florida Statutes (2004-2007), states that committing fraud, deceit or misconduct in the practice of dentistry, shall constitute grounds for discipline by the Board of Dentistry. 59. The Respondent committed fraud, deceit or misconduct in treating Patient M.L. in one or more of the following ways: . a) Respondent failed to perform and/or provide, delivery and seating of the final PFM crown for tooth number 8, as it is nowhere described in the November 2006 treatment notes for Patient M.L. Respondent's billing ledger shows Patient M.L.’s account billed for the final PFM crown on or about November 29, 2006, but there is no visit reflecting that final delivery of the PFM crown at tooth number 8 was performed as charged by Respondent; b) Respondent falsely indicated in treatment notes, and in billing documents for a November 16, 2006, visit that he performed a cast post and core at tooth number 8 of Patient M.L., and failed to accurately note he actually placed a serrated prefabricated post at tooth number 8; c) Respondent falsely billed Patient M.L. for a proposed lower right bridge twice, on or about December 14, 2006, and again on October 5, 2007, and the bridge was never fabricated or delivered by Respondent to the patient; d) Respondent falsely indicated in treatment notes, and in billing documents for an April 25, 2007, visit that he performed a cast post and core at tooth number 28 of Patient M.L., when he knew or should have known he actually placed a serrated prefabricated post at tooth number 28; 33 JAPSU\Medical\wayne mitchell\l-09f.DntiAC's\StamitolesO8-19 142(m)(x)(therwnbrdgfraud.nowrk.doc @) Respondent falsely indicated and charged falsely that he performed pulp cap, build ups and/or crown preps and PFM crowns for teeth numbers 7-10 and 23-26 during an October 5, 2007, visit, when Respondent knew or should have known that work was never provided; f) Respondent failed to accurately treat/bill Patient M.L. for a proposed lower right bridge (twice) again during, the October 5, 2007, visit when Respondent knew or should have known he never performed any such work at teeth sites 28-31. Respondent inaccurately noted again that he did perform crown/bridge work there during this visit when he did not; and/or g) R Respon Want falsely indicated that he remade temporary crowns at teeth numbers 28-32 during Patient M.L.’s final visit October 17, 2007, when he knew or should have known he never. did crown replacement/prep work there. 60. Based on the foregoing, the Respondent has violated 466.028(1)(t), Florida Statutes (2004-2007), by committing fraud, deceit or misconduct in the practice of dentistry. COUNT IV-MISREPRESENTATIONS 61. Petitioner realleges and incorporates paragraphs one (1) through forty-nine (49) as if fully set forth herein. 62. Section 466.028(1)(1), Florida Statutes (2004-2007), states that making, deceptive, untrue or fraudulent representations in or related to the practice of dentistry, shall constitute grounds for discipline by the Board of Dentistry. 34 JAPSU\Medical\wayne mitchell\! -09f DntlAC's\Stamitoles0 8-19 |42(m)(x)(Q)erwnbrdgfraud nowrk.doc 63. The Respondent made deceptive, untrue or fraudulent representations in or related to the practice of dentistry in one or more of the following ways: a) Respondent failed to perform and/or provide, delivery and seating of the final PFM crown for tooth number 8, as it is nowhere described in the November 2006 treatment notes for Patient M.L. Respondent's billing ledger shows Patient M.L.’s account billed for the final PFM crown on or about November 29, 2006, but there is no visit reflecting that final delivery of the PFM crown at tooth number 8 was performed as charged by Respondent; b) Respondent falsely indicated in treatment notes, and in billing documents for a November 16, 2006, visit that he performed a cast post and core at tooth number 8 of Patient M.L., and failed to accurately note he actually placed a serrated prefabricated post at tooth number 8; ¢) Respondent falsely billed Patient M.L. for a proposed lower right bridge twice, on or about December 14, 2006, and again on October 5, 2007, and the bridge was never fabricated or delivered by Respondent to the patient; d) Respondent falsely indicated in treatment notes, and in billing documents for an April 25, 2007, visit that he performed a cast post and core at tooth number 28 of Patient M.L., when he knew or should have known he actually placed a serrated prefabricated post at tooth number 28° @) Respondent falsely indicated and charged falsely that he performed pulp cap, build ups and/or crown preps and PFM crowns for teeth numbers 7-10 and 23-26 during an October 5, 2007, visit, when Respondent knew or should have known that work was never provided; 35 JAPSU\Medical\wayne mitchel\!-09f DntiA C's\Stamitoles08 -19142(m)(x)(Herwnbrdg fraud. nowrk.doc f) Respondent failed to accurately treat/bill Patient M.L. for a proposed lower right bridge (twice) again during, the October 5, 2007, visit when Respondent knew or should have known he never performed any such work at teeth sites 28-31. Respondent inaccurately noted again that he did perform crown/bridge work there during this visit when he did not; g) Respondent falsely indicated that he remade temporary crowns at teeth numbers 28-32 during Patient M.L.’s final visit October 17, 2007, when he knew or should have known he never did crown repiacement/prep work there; and/or h) Respondent made at least three different official misrepresentations that most of the dental treatment that he had charged Patient M.L. for and that she had paid for, had been completed: « Ina January 7, 2008, letter to patient’s daughter, D.P., advising her that “most of the preparation work has been completed and all that remains is impressions.” e Ina March 18, and 19, 2008 response letter to Care Credit claiming “90% work completed.” e In a November 24, 2008, response letter to a Department investigator, claiming that: “all dental work had been completed 90%” “it is our office policy that all work is paid in full before crown and bridge can be cemented, but that on this case M.L. paid ahead of time with her Care Credit so she could get 0% interest.” 64. Based on the foregoing, the Respondent has violated 466.028(1)(1), Florida Statutes (2004-2007), by making, deceptive, untrue or fraudulent representations in or related to the practice of dentistry. 36 J:APSU\Medical\wayne mitchell\ | -09f.DntlAC's\Stamitoles08-19142(m)(x)(t)erwnbrdgfraud.nowrk.doc 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. Assistant General Counsel BEE lice DOH Prosecution Services Unit WEPARTMENT OF HEALTH 4052 Baid Cypress Way, Bin C-65 os aay, DEPUTY QLERK Tallahassee, FL 32399-3265 SUBRK: Cir, Z Cem lori Bar No, 869414 DATE A-2-C7 850.245.4640 Ext. 8189 850.245.4683 FAX pce: {2/04 [04 PCP Members: CM, WW Fé DOH vs. Charles Stamitoles, D.D.&., Case Noa. 2008-19142 J:\PSU\Medical\wayne mitchell\i -09/. DntiAC's\StamitolesO8- 192142(m)(x)(t)crwnbrdgfraud.nowrk.doc 37 JA\PSU\Medicalhwayne mitchell\l-09f DntlAC's\StamitolesO 8- 19 142(m)t x (erwnbrdgfraud nowrk.doc NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 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 Respondernit 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 of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed DOH vs. Charles Stamitoles, D.D.S., Case No. 2008-19142 38 J:APSU\Medical\wayne mitchell\! -09f, DntlAC’s\StamitolesO8- 19 142(m)(x)(Qcrwnbrdg fraud. nowrk.doc

Docket for Case No: 11-006411PL