STATE OF FLORIDA DEPARTMENT OF HEALTH -. DEPARTMENT OF HEALTH, PETITIONER, VS. CASE NUMBER: 2010-02628 JOSEPH GAETA, D.D.S., 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 the Respondent, Joseph Gaeta, 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 11262. 3. Respondent's address of record is 1509 Bayshore Road, Nokomis, Florida, 34275. At all times material to the allegations of this complaint, Respondent's practice location was “Complete Dental” located at 1940 Tamiami Trail #102, Port Charlotte, Florida 33948. 4. The Respondent provided dental care and treatment to Patient J.P. as a regular patient from on or about January 21, 2008, through on or about May 14, 2009. ) 5. After May 14, 2009, Patient J.P. continued treatment at Respondent's former clinic in Port Charlotte after it was sold to a subsequent treater. Patient J.P.’s treatment there continued from at least June through November of 2009. . Deficient Initial Diagnosis/Treatment Plan 6. Onor about January 21, 2008, Patient J.P. presented to the Respondent for a New Patient Dental Examination, and to have tooth number 10 replaced in an existing lower denture. Patient J.P. presented with a 19 year-old implant supported lower fixed over- denture, which was extremely worn. Respondent notated in the treatment notes for Patient J.P.’s initial visit that “Pt said he is interested in implants on upper. Spoke w/pt about sinus graft.” 2 J:\PSU\Medical\wayne mitchell\1-10f..AC's\Gaetal 0-02628(m)(x)impIn.odenture.doc 7, Respondent then formulated a treatment plan to perform ‘bone augmentation surgery (sinus lift) in Patient J.P.’s upper maxilla (both sides), followed by placement of 8 implants in the maxilla; 4 in the upper right (tooth sites 3, 4, 6, and 8), and 4 in the upper left (tooth sites 9, 11, 13, and 14). Respondent's treatment plan then proposed fabrication/seating of an upper fixed over-denture supported by the implants. Patient J.P.’s consent is not indicated by © a signature on the treatment plan document. Respondent's assistant “apparently notated in the treatment notes “Pt wants to do tx.” 8. Respondent failed to perform/notate adequate diagnosis to support performing bone augmentation surgery in Patient J.P.'s maxilla. Respondent did not record adequate diagnostic findings, produce diagnostic casts or take into consideration the condition of the patient’s worn existing lower denture, in treatment planning placement of 8 implants and/or adequately diagnose the patient's existing occlusion when planning for a new upper over-denture opposite the 19 year-old fixed lower denture. As part of treatment planning, Respondent also failed to fabricate/utilize a surgical stent- 3 JAPSU\Medical\wayne mitchell\1-10£.AC's\Gaetal 0-02628(m)(x)impin.odenture.doc guide to assist in the proper placement of 8 implants vis-a-vis existing occlusion of the lower denture. 9. Respondent's treatment notes for the initial visit/exam do not contain a medical history document. There is nothing in Respondent's treatment plan or notes to indicate that an explanation of treatment options, including risks/benefits of each, was ever presented for Patient J.P. to provide his informed consent. 10. Respondent proceeded with the proposed course of treatment and performed sinus augmentation surgery in Patient J.P.’s mouth on or about February 19, 2008. Following several post- op follow-up visits, on or about July 14, 2008, Respondent surgically placed eight implants in Patient J.P.’s maxilla at tooth sites 2, 3, 4, 6, 9, 10, 13 and 15. In October 2008, Respondent noted post-op that some bone loss and infection was apparent at implant site number 9. Abutments were restored on the implants on or about January 12, 2009. 11. In April and May 2009, Respondent took impressions and fitted a Hader Bar for the final fixed upper over-denture. On or about May 14, 2009, Respondent cemented the retaining Hader Bar 4 . J:\PSU\Medical\wayne mitchell\1-10f..AC's\Gaetai 0-02628(m)(x)impln.odenture.doc to the implants, and delivered the final fixed over-denture in Patient J.P.’s upper mouth. 12. Respondent apparently sold the Complete Dental Clinic in Port Charlotte to a subsequent dentist in or about June-July 2009. In July and November 2009, Patient J.P. returned to the Complete Dental Clinic complaining of broken teeth in the new upper and/or lower over-denture, which the subsequent dentist attempted to repair. Defective Fixed Upper Over-denture 13. Respondent improperly fabricated and seated a defective prosthesis in Patient J.P.’s mouth. In fabricating the over-denture, Respondent cemented a “Hader Bar” to the implants, to which clips attached to help retain the acrylic fixed denture in the patient’s upper mouth. The bar due to its bulkiness encroached upon the position of Patient J.P.’s upper right front teeth and caused malocclusion to include a 2 millimeter overbite and 2 millimeter overjet when Patient J.P. closed his mouth. The result included a lack of anterior guidance and balancing interferences ‘in. lateral excursions in Patient J.P.’s occlusion causing the upper right denture . 5 J:A\PSU\Medical\wayne mitchell\1-1 0f..AC's\Gaetal 0-02628(m)(x)impln.odenture.doc teeth to improperly and forcefully contact the worn lower denture teeth, leading to constant pressure and breaking of the teeth. A different design was indicated, and/or simultaneously replacing the teeth in the lower denture with shorter ones to compensate for the new upper over-denture. 14. The Respondent's course of treatment from on or about January 21, 2008, through on or about May 14, 2009, primarily focused on the placement/restorations of implants and seating of a fixed over-denture in the upper region of Patient J.P.‘s mouth and neglected the overall comprehensive dental needs and treatment of Patient J.P., to include failing to account for the altered occlusion vis- a-vis the existing lower over-denture. 15. The prevailing standard of diagnosis and treatment for rendering dental care requires a dentist to perform an adequate ‘ comprehensive initial clinical evaluation of any patient to include an evaluation for pathology, condition of the teeth and/or oral cavity and TMJ, presence and condition of existing restorations to include prosthetic appliances and existing occlusion, and any pertinent radiographic findings. After an examination, the dentist should . 6 J:\PSU\Medical\wayne mitchell\1-10f..AC's\Gaetal 0-02628(m)(x)imp!n.odenture, doc formulate a comprehensive treatment plan with treatment alternatives and present the patient with the treatment plan to ensure full informed consent. The Respondent failed to meet this standard. Subsequent Review/Agency Expert 16. On or about August 5, 2009, Patient J.P. presented to a Subsequent Treater, a board-certified specialist in oral-maxillofacial surgery with expertise in prosthodontics. The Subsequent Treater’s clinical notes ranging from August through November 2009, indicate that Patient J.P. presented initially due to a lower right tooth fracturing off the lower over-denture. Patient J.P, also complained to the Subsequent Treater that upper right teeth fractured numerous times off the upper over-denture fabricated by the Respondent. 17. The Subsequent Treater performed a diagnostic exam and determined that the implant-supported over-denture in Patient J.P.’s maxilla was fabricated improperly by the Respondent. In fabricating the over-denture, Respondent cemented a “Hader Bar” to the implants, to which clips attached to retain the acrylic fixed denture in the patient’s upper mouth. The bar, due to its bulkiness, 7 JAPSU\Medical\wayne mitchell\1-10£.AC's\Gaetal 0-02628(m) (x)impln.odenture.doc encroached upon the position of Patient J.P.’s upper right front teeth and caused malocclusion to include a 2 millimeter overbite, and 2 millimeter overjet when Patient J.P. closed his mouth. 18. The subsequent treater determined that there was a lack of anterior guidance and balancing interferences in lateral excursions in Patient J.P.’s occlusion causing the upper right denture teeth to improperly and forcefully contact the worn lower denture teeth, leading to constant pressure and breaking of the teeth, It was determined that a properly planned course of treatment should have accounted for the worn occlusion pattern in Patient J.P.’s older lower : over-denture, either by appropriate adjustment of the length of the teeth and/or replacing the teeth in the lower over-denture with shorter restorations to compensate for the new upper over-denture. | 19. Patient J.P. subsequently filed this complaint against Respondent on or about March 11, 2010, alleging that since Respondent seated the upper over-denture in May 2009, the teeth of the dentures were continuously fracturing and/or falling out. ) 20. An independent expert dentist retained by the Department to review this complaint opined that the Respondent , 8 J:\PSU\Medical\wayne mitchell\1-10f..AC's\Gaetal 0-02628(m)(x)impin.odenture.doc failed to properly diagnose existing conditions in Patient J.P.’s mouth, and failed to properly. treatment plan this prosthetic course of treatment to account for the alteration in occlusion when the new upper over-denture was placed in opposition to the existing lower over-denture. The result was an improperly designed and defective fixed upper over-denture seated by the Respondent. Respondent also failed to properly record indicated diagnoses and exam results to justify the course of treatment. COUNT I: STANDARD O E 21. Petitioner re-alleges and incorporates paragraphs one (1) through twenty (20) as if fully set forth herein. 22. Section 466.028(1)(x), Florida Statutes (2007-2008), provides that “[bJeing 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[,]” shall constitute grounds for disciplinary action by the Board of Dentistry. 9 . J:\PSU\Medical\wayne mitchell\1-10f..AC's\Gaeta10-02628(m)(x)impIn.odenture.doc 23. Respondent failed to meet the minimum standards of performance in diagnosis and treatment when measured against generally prevailing peer performance in one or more of the following ways: A. By failing to perform an adequate initial clinical evaluation, to include but not limited to, making adequate diagnostic findings, produce diagnostic casts and/or assessing the condition of the patient’s worn existing lower denture, in treatment planning placement of 8 implants, and/or a fixed upper over- denture; B. By failing, on or about January 21, 2008, to formulate an adequate diagnosis and/or treatment plan with alternatives and risks and benefits presented to Patient J.P.; C. By neglecting Patient J.P’s comprehensive dental needs from on about January 21, 2008, through on or about May 14, 2009, and focusing primarily on an upper maxilla new over-denture; D. By failing to perform/notate adequate diagnosis to support performing bone augmentation surgery in Patient J.P.’s maxilla in January-February 2008; E. By failing to adequately diagnose the patient’s existing occlusion when planning for a new upper over-denture opposite a 19 year old fixed lower denture; F. By failing to fabricate/utilize a surgical stent-guide or diagnostic casts to assist in the proper placement of 8 implants and/or the upper over-denture vis-a-vis existing occlusion of the lower denture as part of JAPSU\Medical\wayne mitchell\1-10f..AC's\Gaetal 0-02628(m)(x)impIn. odenture.doc treatment planning and subsequent treatment; and/or,’ _ By fabricating and seating a defective prosthesis in Patient J.P’s mouth. Respondent cemented a “Hader Bar” to the implants, to which clips attached to help retain the acrylic fixed denture in the patient’s upper mouth. The bar due to its bulkiness encroached upon the position of Patient J.P’s upper right front teeth and caused malocclusion to include a 2 millimeter overbite, and 2 millimeter overjet when Patient J.P. closed his mouth. The result included a lack of anterior guidance and balancing interferences in lateral excursions in Patient J.P’s occlusion causing the upper right denture teeth to improperly and forcefully contact the worn lower denture teeth, leading to constant pressure and breaking of the teeth. A different design was indicated, and/or simultaneously replacing the teeth in the lower denture with shorter ones to compensate for the new upper over-denture. Based on the foregoing, Respondent has violated Section 466.028(1)(x), Florida Statutes (2007-2008), 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. 11 J:\PSU\Medical\wayne mitchell\1-10f..AC's\Gaeta! 0-02628(m)(x)impin.odenture.doc COUNT II: RECORD KEEPING 25. Petitioner re-alleges and incorporates paragraphs one (1) . through twenty (20) as if fully set forth herein. , 26. Section 466.028(1)(m), Florida Statutes (2007-2008), provides that “[fJailing 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. Rule 64B5-17.002, Florida Administrative Code, further provides that a dentist shall maintain written records on each patient which written records shall contain, at a minimum, the following information about the patient: 1) Appropriate medical history; 2) Results of clinical examination and tests conducted, including the identification, or lack thereof, of any oral pathology or diseases; 3) Any radiographs used for the diagnosis or treatment of the patient; 4) Treatment plan proposed by the dentist; and 5) Treatment rendered to the patient. 12 J:APSU\Medical\wayne mitchell\1-10£.AC's\Gaetal 0-02628(m)(x)impin.odenture.doc 27. Respondent failed to keep written dental records and medical history records justifying the course of treatment of Patient J.P. in one or more of the following ways: A. By failing, throughout the entire course of treatment, to document an appropriate and adequate medical history for Patient J.P.; By failing to perform/notate adequate diagnosis to support performing bone augmentation surgery in Patient J.P’s maxilla in January-February 2008; By failing to record adequate diagnostic findings, or take into consideration and record the condition of the patient's worn existing lower denture, in treatment planning placement of 8 implants and/or - seating of a fixed upper over-denture; By failing to fully record Patient J.P’s consent by not indicating it on a signature on the treatment plan document; and/or By failing, on or about January 1, 2008, to document, if so done, the explanation of treatment options, including risks/benefits for Patient J.P. to provide informed consent. 28. Based on the foregoing, Respondent has violated Section 466.028(1)(m), Florida Statutes (2007-2008), by failing to keep written dental records and medical history records justifying the - course of treatment of Patient J.P. B J\PSU\Medical\wayne mitchell\1-10£.AC's\Gaetal 0-02628(m)(x)impIn.odenture.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. 1, SIGNED this__/7 dayof_ 7p 4% , 2010. Ana Viamonte Ros, M.D., M.P.H. State Surgeon General H. pe . Assistant General Counsel DOH Prosecution Services Unit HT OF eae 4052 Bald Cypress Way, Bin C-65 DEPART ity cuEnt Tallahassee, Florida 32399-3265 ange ne Florida Bar # 869414 cuERK GGT 18 201 850.245.4640 FAX: 245.4683 pcp: 10/18/70 PCP Members: DG, WA, WR DOH J.P.. Joseph Gaeta, D.D.S., Case No, 2010-02628 14 J:\PSU\Medical\wayne mitchell\1-10£.AC's\Gaetal 0-02628(m)(x)impIn.odenture.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 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 of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed. J:\PSU\Medical\wayne mitchell\1-10£ .AC's\Gaetal 0-02628(m)(x)impln.odenture.doc

Docket for Case No: 13-003866PL