STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO.: 2009-21902 CARL T. PANZARELLA, DDS RESPONDENT, __/ 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 Respondent, CARL PANZARELLA, DDS, 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 Compiaint, Respondent was a licensed dentist within the State of Florida, having been issued license number DN 8948, 3. Raspondent’s address of record is 2260 West Bay Drive, Suite A, Largo, Florida 33770. Filed July 3, 2012 8:27 AM Division of Administrative Hearings PATIENT Y.P. 4. From on or about July 9, 2009, through on or about September 24, 2009, the Respondent provided dental care to Patient Y.P. 5. On or about July 9, 2009, Patient Y.P. first presented to Respondent. Patient Y.P, was given a new patient exam and a full mouth series of radiographs. Respondent did not perform/record a review of Patient Y.P’s medical history. There was no periodontal exam performed/recorded. There is a partial listing of periodontal probings, but the probings are not fully performed/recorded. No diagnosis was recorded for the periodontium. No periodontal care was treatment planned for Patient Y.P. Extractions are treatment planned for teeth numbers 1 and 32, along with restorations of teeth numbers 15, 18, 30, and 31. 6. On or about July 16, 2009, Patient yp presents to the Respondent again. Teeth numbers 1 and 32 are extracted. Respondent does not receive/record informed consent for the extractions. Respondent did not record the amount or type of local anesthetic that was used for the extractions. 7, On or about September 24, 2009, Patient YP. speaks to the Respondent over the phone regarding her remaining care. Patient Y.P. did not return to the Respondent thereafter. JAPSU\Medical\Dentistry\George Black\AC 11\Panzarella 2009-21962 (x}(m) extractions ret.doc -2- PATIENT R.P. 8. | From on or about July 14, 2009, through on or about September 24, 2009, the Respondent provided dental care to Patient R.P. 9. On or about July 14, 2009, Patient R.P. first presented to the Respondent. Patient R.P. was given a new patient examination, including a full mouth series of radiographs. The dental charting is incomplete, showing missing teeth, but not existing restorations. There is a partial listing of periodontal probings, but the probings are not Fully performed/recorded. No diagnosis was recorded for the periodontium. No periodontal care is treatment planned for Patient R.P. Patient R.P. was treatment planned for a root canai treatment and subsequent crowning of tooth number 19. 10. On or about August 17, 2009, Patient R.P. presented again to the Respondent, at-which time a root canal treatment was initiated on R naent does not receive/record informed consent for the root canal treatment. Respondent did not record the amount or type of local anesthetic that was used for the root canal treatment, The Respondent did not use/record a rubber dam for isolation, or record a justification that a rubber dam could not be used for isolation. No JAPSU\Medical\Dentistry\George Black\AC 11\Panzarella 2009-21902 (x}im) extractions ret.doc -3- radiographs for this visit are in the record, and no radiographic findings were documented. 11. On or about August 24, 2009, Patient R.P. presented to the Respondent for the completion of the root canal treatment on tooth number 19. Only one radiograph was exposed. There are no Findings from this radiograph documented in the patient record. No radiographs are taken of the final results of the endodontic treatment. Respondent did not record the amount or type of local anesthetic that was used for the root canal treatment. 12, The minimum standard of care in the practice of dentisiry for endodontic therapy requires a dentist to take and review postoperative radiographs immediately after a root canal treatment. A postoperative radiograph provides a means to evaluate the final fill of the root canal treatment. If a complication is observed, the Drognosis for successful repair is best when immediately addressed, 13. During the completion of the root canal treatment on tooth number 19, the Respondent did not use/record a rubber dam for isolation, or record a justification that a rubber dam could not be used for isolation. Review of the radiograph clearly indicates that there is no clamp placed to hold a rubber dam. JAPSU\Medical\Dentistry\George Black\AC 11\Panzarella 2009-21902 Ox)(m) extractions ret.dac 74m 14, The minimum standard of care in the practice of dentistry for endodontic treatment requires a dentist to use a rubber dam when performing a root canal treatment or to document proper justification of why a rubber dam was not used. The use of a rubber dam during endodontic procedures isolates the tooth from the environment, including but not limited to, bacteria from the oral cavity. If the root canal becomes contaminated, the tooth may need to be retreated, the tooth may be lost, and the infection can spread to the jawbone. The use of a rubber dam also protects the patient's airway and digestive track from any materials which may fall into it during treatment. Aspiration or ingestion of dental instruments can be fatal. 15. On or about October 14, 2009, Patient R.P. presented to Respondent at Respondent’s request, as Patient R.P’s insurance required for payment a final radiograph of the root canal treatment of tooth number 19. Patient R.P. left and returned, at which point a dispute arose regarding the amount that Patient R.P. would have to pay for the root canal treatment. Patient R.P. did not return to the Respondent thereafter, JAPSU\Medical\Dentistry\George Black\AC 11\Panzarella 2009-21902 (x}(m} extractions ret.doc “oo COUNT I: DEFICIENT RECORDKEEPING 16. Patitioner re-alleges the allegations contained in paragraphs one (1) through fifteen (15) as if fully incorporated herein, 17. Section 466.028(1)(m), Florida Statutes (2009), 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 results, and X rays, if taken, constitutes grounds for disciplinary action by the Board of Dentistry, 18. Rule 64B5-17.002(b), Florida Administrative Code, provides that for the purpose of implementing the provisions of Section 466.028(1}(m), Florida Statutes, a dentist shall maintain written records on each patient which written records shall contain the results of clinical examination of the patient and tests conducted, including the identification, or lack thereof, of any oral pathology or diseases, radiographs used for the diagnosis or treatment of the patient, treatment plan proposed by the dentist, and treatment rendered to the patient, 19. Respondent failed to keep written dental records and medical history records, properly justifying the course of treatment or the results of treatment of Patient Y.P. in the following manner: JAPSU\Medical\Dentistry\George Black\AC 11 \Panzarelia 2009-21902 (x)(m) extractions ret.doc -6§- 1) Respondent's notes do not include a comprehensive periodontal examination for Patient Y.P,, including, but not limited to, the health of the gingival, tooth mobility and/or a complete detailed periodontal pocket depth charting; 2) Respondent failed to record a diagnosis of the health of periodontium for Patient Y.P.; 3) Respondent did not document a review of Patient Y.P’s medical history as part of the new patient examination on or about July 9, 2009; 4) Respondent failed to record the informed consent of Patient Y.P. for the extractions of teeth numbers 1 and/or 32 either by a completed informed consent form or by a notation in the record; and/or 5) Respondent failed to record the amount and/or type of anesthetic used in the extractions of teeth numbers 1 and/or 32. 20, Respondent failed to keep written dental records and medical history records, properly justifying the course of treatment or the results of treatment of Patient R.P. in the following manner: JAPSU\Medical\Dentistry\George Black\AC 11\Panzarella 2009-21902 (x){m) extractions ret.doc -7- 1) Respondent's notes do not include a comprehensive periodontal examination for Patient R.P,, including, but not limited to, the health of the gingival, tooth mobility and/or a complete detailed periodontal pocket depth charting; 2) Respondent failed to record a diagnosis of the health of the periodontium for Patient R.P. ; 3) Respondent failed to record the informed consent of Patient R.P. for the root canal treatment of tooth number 19 either by a completed informed consent form or by a notation in the record; 4) Respondent failed to record the amount and/or type of anesthetic used in the root canal treatment of tooth number 19: 5) Respondent failed to record either the use of a rubber dam for isolation or, alternatively, any justification for failing to use a rubber dam for isolation; 6) Respondent failed to record any findings from the radiographs taken; and/or JAPSU\Medical\Dentistry\George Black\AC i ]\Panzarelia 2006-21902 (x}(m)} extractions ret.doc 7) Respondent failed to take adequate diagnostic comprehensive radiographs necessary to justify the various treatments. | 21, Based on the foregoing, Respondent has violated Saction 466.028(1)(m), Florida Statutes (2009), by falling to keep written dental records and medical history records justifying the course of treatment of Patient R.P and/or Y.P. COUNT II: STANDARD OF CARE 22. Petitioner re-alleges the allegations contained in paragraphs one (1) through fifteen (15) as if fully incorporated herein. 23, Section 466.028(1)(x), Florida Statutes (2009), states that “[bJeing guilty of incompetence or negligence by failing to meet the minimum stanaards 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 maipractice[,]” shall constitute grounds for disciplinary action by the Board of Dentistry. JAPSU\Medical\Dentistry\George Black\AC 11\Panzarelia 2009-21902 (x}{m) extractions ret.do¢ -9- 24, The Respondent was negligent and failed to meet minimum standards of dental performance in diagnosing and treating Patient Y.P. in one or more of the following ways: a) Respondent failed during the initial patient exam to perform a comprehensive periodontal examination including, but not limited to, the health of the gingival, tooth mobility and/or a complete detailed periodontal pocket depth charting; b) Respondent failed to review the medical history of Patient Y.P. as part of the new patient examination; c) Respondent failed to provide a diagnosis of the periodontal health; d) Respondent failed to treatment plan any periodontal care; and/or @) Respondent failed to receive informed consent for the extractions of teeth numbers 1 and 32. either by a compieted informed consent form or any other means, 25. The Respondent was negligent and failed to meet minimum stanaards of dental performance in diagnosing and treating Patient R.P. in one or more of the following ways: UAPSU\Medicall\Dentistry\George Black\AC I 1\Panzarella 2009-21902 (x}(m) extractions ret.dac -10- a) Respondent failed during the initial patient exam to perform a comprehensive periodontal examination including, but not limited ta, the health of the gingival, tooth mobility and/or a complete detailed periodontal pocket depth charting; b) Respondent failed to provide a diagnosis of the periodontal health; Cc) Respondent failed to treatment plan any periodontal care; d) Respondent failed to receive informed consent for the root canal treatment of tooth number 19, either by a completed informed consent form or by any other means; @) Respondent failed to use a rubber dam for isolation during the root canal treatment of tooth number 19, or alternatively provide a medically justified reason for the failure to use a rubber dam for isolation; and/or f) Respondent failed to take adequate diagnostic comprehensive radiographs necessary to properly diagnose, treatment plan and/or perform the necessary treatments. JAPSU\Medical\Dentistry\George Black\AC 11\Panzarella 2009-21902 (x)(m) extractions ret.doc 26. Based on the foregoing, the Respondent has violated Section 466.028(1)(x), Florida Statutes (2009), 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 malpractica. WHEREFORE, Patitioner respectfully requests that the Board of Dentistry enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the FAPSU\Medical\Dentistry\George Biack\AC | ]\Panzarella 2009-21902 (x}im) extractions ret.doc -i2- SIGNED this 30" Day of September, 2011. FILED DEPARTMENT OF HEALTH DEPUTY CLERK CLERK Melisa A) DATE 4-30 ie PCP; 9-23-11 PCP Members: CM, JT & FG H. Frank Farmer, Jr, MD, PhD, FACP State Surgeon General George Black Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Florida Bar # 0061639 850.245.4640 850.245.4683 FAX DOH v. CARL T. PANZARELLA, D.D.S., Case #2009-21902 JAPSU\Medical\Dentistry\George Biack\AC 11\Panzarelia 2009-21902 Oxjim) extractions reLdoc -13~- 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 Respondent is placed on notice that Petitioner has incurred cests 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 attorn y hours and costs a 7 on the Respondent in addition to any other discipline imposed, DOH v. CARL T. PANZARELLA, D.D.S., Case #2009-21902 FAPSU\Medical\Dentistry\George Biack\AC 1] \Panzarella 2009-21902 (x}(m) extractions ret.doc -i4-

Docket for Case No: 12-002294PL