Charles S. Baldwin, D.D.S.,
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.
Respondent is, and has been at all times material hereto, a licensed dentist in the State of Florida, having been issued license number DN 7657.
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J:\PSU\Medical\Dentistry\David Flynn\Admin Complaints\2009\May\Baldwin (m)(x-raysmissing)(2).doc
Filed August 15, 2012 4:14 PM Division of Administrative Hearings
Respondent's address of record is 14570 S. Military Trail Ste C-
2, Delray Beach, Florida 33484
From on or about January 13, 2003, through on or about September 14, 2007, Respondent provided dental treatment to Patient J.C.
During this period of treatment, Subjec_t took multiple
radiographs of Patient J.C.'s dentition for diagnostic purposes. Dental radiographs serve as a critical diagnostic tool that are used in conjunction with appropriate clinical examinations for the dentist to ensure for proper diagnosis, treatment planning and treatment. Among many other uses, dental radiographs can be used to help diagnose tooth decay, to help to determine the quality and quantity of available alveolar bone prior to the placement of dental implants, to help diagnose periodontal disease and to help uncover abnormalities in the bone such as possible cysts, tumors and/or
malignancies. Further, radiographs are utilized to chart the progress of the
patient's dental condition over a period of time and can be looked at in the future as a baseline with regards to a patient's prior oral condition. Dental radiographs are quite integral to the proper placement of dental implants, to the tracking of the osseo-integration of dental implants, and to determine whether the dental implants were surgically placed in the appropriate
positions within the bone of the mandible or the maxilla. Dental radiographs are also a beneficial tool in communicating with other dentists and are often transferred to subsequent treating dentists to help ensure quality continuity of treatment. Moreover, dental radiographs are generally the most direct and definitive piece of tangible evidence utilized in court proceedings when it is alleged a dentist has practiced below minimum standard of dental diagnosis, treatment planning and/or treatment. Simply stated, dental radiographs play a crucial and key role in the treatment of most every patient and as such all dental radiographs must be maintained by a dentist within the patient treatment records.
From on about January 13, 2003, through on or about April 4, 2005, Patient J.C. presented to Respondent multiple times for treatment and during this time the Respondent1s treatment records indicate that Respondent took dental radiographs on the following dates:
On or about January 13, 2003; and
On or about November 24, 2003.
On or about April 16, 2007, through on about September 14, 2007, Patient J.C. presented to Respondent for placement of four implants in his lower arch to support an over-denture, a complete denture that is
supported by natural teeth and/or dental implants. During this period of treatment, Respondent placed four implants which began to fail and during this time the records indicate that Respondent took radiographs on the following dates:
On or about April 16, 2007;
On or about June 7, 2007;
On or about June 20, 2007; and
On or about September 10, 2007.
The radiograph dates enumerated in paragraphs six (6) and paragraph seven (7) above may not be a comprehensive listing of all radiographs taken, but reflects what was documented by Respondent in Patient J.C.'s patient treatment records as well as could be deciphered.
Patient J.C. discontinued treatment with Respondent after on or about September 14, 2007, due to dissatisfaction with the failing implants and on or about May 23, 2008, filed a Uniform Complaint Form with the Florida Department of Health alleging Respondent failed to meet the minimum standard of care in diagnosis, treatment planning and treatment regarding Respondent's placement and restoration of dental implants in Patient J.C.'s mandible, the lower arch.
On or about May 8, 2008, Patient J.C. signed an authorization for a release of medical records to the Florida Department of Health to obtain an entire copy of Patient J.C.'s patient treatment records to include, but not limited to, all dental radiographs from Respondent.
On or about June 23, 2008, the Florida Department of Health issued a Subpoena Duces Tecum, number 0052576, to Respondent for a complete copy of all treatment records to include all dental radiographs regarding the treatment of Patient J.C. The Subpoena demanded compliance by July 7, 2008.
Respondent was non-compliant with the Subpoena. An Investigator from the Florida Department of Health made repeated phone calls regarding providing the complete patient treatment records, including all dental radiographs, and Respondent asserted that the file was in storage. Thereafter, Respondent did not comply with the Subpoena. Rather, Respondent contacted counsel and informed the Department Investigator that an attorney was retained.
On or about August 13, 2008, Respondent produced through counsel a copy of Respondent's treatment records for Patient J.C. without providing any dental radiographs. Respondent asserts that he sent the
original x-rays to Patient J.C.'s attorney. Respondent does not have copies of any of the dental radiographs that were taken of Patient J.C. during the course of treatment as documented in the Respondent's patient treatment records.
Contact was made by the Department Investigator, again requesting the production of the dental radiographs that were taken of Patient J.C. On or about August 29, 2008, counsel for Respondent asserts that the radiographs have not been returned from Patient J.C.'s attorney.
The Department Investigator contacted Patient J.C.'s attorney who asserted that Respondent never provided or released any radiographs to him or his client, Patient J.C. Patient J.C.'s attorney's assertions are confirmed in a written document dated September 17, 2008.
Respondent is unable to produce any dental radiographs for the entire course of treatments that were provided to Patient J.C. Respondent has either failed to appropriately maintain the dental radiographs or improperly released the dental radiographs.
The Respondent's dental implant diagnosis, treatment planning and/or treatment cannot be verified or justified by a review of the patient treatment records because the Respondent has failed to maintain the original
radiographs or copies of the original dental radiographs which were utilized as a diagnostic, treatment planning and treatment tool in conjunction with the Respondent's clinical examination of Patient J.C.
Section 466.028(1)(m), Florida Statutes (2002-2007) states that failing to keep 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 radiographs, if taken, constitutes grounds for disciplinary action by the Board of Dentistry.
Rule 64B5-17.002, Florida Administrative Code, "for purposes of implementing the provisions of subsection 466.028(1)(m)," requires that a dentist maintain for each patient written records that require, 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.
Further, Rule 64B5-17.002 (l)(f), Florida Administrative Code
specifically mandates that, "[w]henever patient records are released or transferred, the dentist releasing or transferring the records shall maintain either the original records or copies thereof and a notation shall be made in
the retained records indicating to whom the records were released or transferred."
Respondent failed to keep dental records and medical history records justifying the course of treatment of Patient J.C. in one or more of the following ways:
By faili ng to maintain a copy of any and all dental radiographs through the course of treatment from on or about January 13, 2003, through on or about April 4, 2005, to include, but not limited to, the Respondent's documented taking of radiographs on or about January 13, 2003, and on or about November 24, 2003, and/or any other radiographs taken during this course of treatment not documented in Respondent's treatment records for Patient J.C.;
By failing to maintain a copy of any and all dental radiographs through the course of treatment from on or about April 16, 2007, through on or about September 14, 2007, to include but not limited to, the Respondent's documented taking of radiographs on or about April 16, 2007; June 7, 2007, June 20, 2007; and/or on or about September 10, 2007, and/or any other radiographs taken during this course of treatment not documented in Respondent's treatment records for Patient J.C.;
By releasing any one or all of the original dental radiographs taken of Patient J.C. by Respondent in his course of treatment from on or about January 13, 2003, through on or about April 4, 2005, without maintaining copies or failing to keep the originals and releasing copies; and/or
By releasing any one or all of the original dental radiographs taken of Patient J.C. by Respondent in his course of treatment from on or about April 16, 2007, through on or about September 10, 2007,- without maintaining copies or failing to keep the originals and releasing copies.
Based on the foregoing, the Respondent's license to practice dentistry in the State of Florida is subject to discipline pursuant to Section 466.028(1)(m), Florida Statutes (2002-2007), as implemented by Rule 64BS- 17.002, Florida Administrative Code, for 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 radiographs, if taken.
