STATE OF FLORIDA BOARD OF DENTISTRY DEPARTMENT OF HEALTH, PETITIONER, v. CASENO: 2013-15361 ANATOLY RIPA, 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 Respondent, Anatoly Ripa, 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 16596. 3. Respondent's address of record is 11880 SW 40" Street, Suite 215, Miami, Florida 33175. 4. On or about May 21, 2013, Patient A.K. presented to Respondent's practice for a limited examination of tooth number 31. 5. Respondent recommended root canal treatment for tooth number 31, and the extraction of Patient A.K.’s “wisdom teeth” (teeth numbers 1, 16, 17, and 32). 6. On that date, Respondent performed root canal treatment on tooth number 31. 7. The American Dental Association publishes the Code on Dental Procedures and Nomenclature (CDT) which contains codes for dental procedures for the purposes of reporting and billing for dental treatment. 8. According to the clinical record for May 21, 2013, in addition to root canal treatment, Respondent performed and billed for a “D4241” procedure, which is the CDT code for “[g]ingival flap procedure, including root planing — one to three contiguous teeth, or tooth bounded spaces per quadrant.” 9. Respondent's clinical record for May 21, 2013, did not indicate a diagnosis to support or treatment that necessitated a gingival flap procedure. 10. Respondent's clinical record for May 21, 2013, did not otherwise indicate that a gingival flap procedure was performed on that cate. 2 11. On or about May 28, 2013, Patient A.K. presented to Respondent's practice for a comprehensive oral examination and the extraction of teeth numbers 1, 16, 17, and 32. 12. As part of the examination, Respondent performed periodontal “spot probing,” in which he used a periodontal probe to measure the depth of the space between Patient A.K.’s teeth and gums. This measurement serves as an indication of whether a patient has periodontal disease. 13. According to the clinical record, Respondent noted the results of Patient A.K.’s periodontal spot probing to be “WNL,” or “within normal limits.” 14. According to the clinical record for that date, Respondent also performed and billed for a “D4355” procedure, which is the CDT code for a full mouth debridement, described as “[t]he gross removal of plaque and calculus that interfere with the ability of the dentist to perform a comprehensive oral evaluation [...].” 15. Respondent's clinical record for May 28, 2013, did not indicate the presence of gross plaque and/or calculus that interfered with his ability to perform a comprehensive oral evaluation. 16. Respondent's clinical record for May 28, 2013, did not indicate a diagnosis to support or necessitate the performance of a full mouth debridement in Patient A.K on that date. 17. Respondent's clinical record for May 28, 2013, did not otherwise indicate that a full mouth debridement was performed on that date. 18. According to the clinical record for May 28, 2013, Respondent also performed and billed for a “D8090” procedure, further described in Respondent's clinical record as “comp ortho, invisalign.” 19. The CDT code “D8090” is the code for “comprehensive orthodontic treatment of the adult dentition.” 20. The CDT code “D8090” is used for the initial placement of orthodontic appliances and the beginning of active treatment. By the use of the code “D8090,” Respondent represented in the clinical record for that date that he provided a complete case (treating both the upper and lower arches) with an Invisalign® brand orthodontic device to Patient A.K. 21. Respondent's clinical record for May 28, 2013, did not indicate a diagnosis to support the initiation of orthodontic treatment for Patient A.K. on that date. 22. Respondent's clinical record for May 28, 2013, did not otherwise indicate that Respondent provided comprehensive orthodontic treatment to Patient A.K. on that date. 23. The minimum standard of performance in diagnosis and treatment in the practice of dentistry requires a dentist to provide an accurate diagnosis of a patient’s dental condition before proceeding with extractions. 24, Respondent diagnosed all four of Patient A.K.’s “wisdom teeth” as complete bony impactions with unusual surgical complications. 25. The radiographs Respondent took on or about May 21, 2013, and/or on or about May 28, 2013, prior to the extractions do not support this diagnosis. . 26. Respondent failed to accurately diagnose Patient A.K.’s dental condition before proceeding with extractions. 27. According to the clinical record, Respondent performed and billed for a “D7241” procedure for each “wisdom tooth,” which is the CDT code for “removal of impacted tooth — completely bony, with unusual surgical complications.” 28. The CDT code “D7241” is used to indicate the performance of an extraction where most or all of the dental crown is covered by bone, and the procedure is unusually difficult or complicated due to factors such as nerve dissection required, separate closure of maxillary sinus required or aberrant tooth position. 29. Respondent noted in the clinical record for May 28, 2013, that he removed buccal/lingual bone with a surgical handpiece and extracted the teeth via elevators and forceps. 30. Respondent did not note any conditions in the clinical record(s) for May 21, 2013, and/or May 28, 2013, which would indicate that the extractions should be considered unusually difficult or complicated. 31. The minimum standard of performance in diagnosis and treatment in the practice of dentistry requires a dentist to properly diagnose whether a tooth’s roots are intact following an extraction. 32. On or about May 28, 2013, Respondent extracted Patient A.K.’s tooth number 17. 33. According to the clinical record for that date, Respondent “{rJecovered all roots intact.” 34. A fragment of tooth number 17 remained in the extraction site. 35. Patient A.K. underwent additional surgery with a subsequent treating dentist to remove the fragment of tooth number 17. 36. Respondent failed to recognize that the roots of tooth number 17 were not intact upon extraction. 37. Respondent represented in the clinical record for May 28, 2013, that he also performed alveoloplasty on Patient A.K.’s upper right quadrant, upper left quadrant, lower left quadrant, and lower right quadrant. 38. A™“quadrant” is defined as one of four equal sections into which the dental arches can be divided. Each quadrant begins at the midline of the arch and extends distally to the last tooth in the back of the mouth. 39. Alveoloplasty is the surgical shaping and smoothing of the margins of the tooth socket after the extraction of the tooth, sometimes in preparation for a dental prosthesis. 40. Alveoloplasty is typically performed as part of the surgical procedure when removing an impacted tooth. 41. Respondent represented that he performed alveoloplasty as a distinct procedure from the extraction of teeth numbers 1, 16, 17, and 32. 42. According to the clinical record for May 28, 2013, Respondent performed and billed for a “D7310” procedure for each quadrant, which is the CDT code for “alveoloplasty in conjunction with extractions — four or more teeth or tooth spaces, per quadrant is used when bone recontouring is performed involving four or more teeth or tooth spaces.” 43. The use of CDT code “D7310” is appropriate when multiple teeth (four or more) within a quadrant of the mouth are extracted and the alveolar bone surrounding a tooth requires smoothing and/or reduction. 44. The clinical record for May 28, 2013, did not otherwise support Respondent's representation that he performed an alveoloplasty procedure for each quadrant of Patient A.K.'’s mouth following the extraction of four or more teeth within each of those quadrants. 45. On or about June 18, 2013, Patient A.K. presented to Respondent's practice for preparation of a crown on tooth number 31 (the tooth that received root canal treatment on or about May 21, 2013). 46. According to the clinical record for that date, Respondent took a preliminary impression to fabricate a temporary crown, he prepared the tooth by reducing the occlusal surface, and he retracted the soft tissue surrounding the tooth with an Expasyl® brand temporary gingival retraction system in order to take the final impression for the permanent crown, Respondent took the final impression and then fitted the tooth with the temporary crown. 47. According to the clinical record for June 18, 2013, Respondent also performed and billed for a “D4249” procedure, which is the CDT code for “clinical crown lengthening — hard tissue.” 48. When preparing a tooth for a permanent restoration such as a crown, it is sometimes necessary to perform a “crown lengthening” procedure when there is an insufficient amount of tooth structure present above the gum line to adequately support the crown. 49. During a crown lengthening procedure, the dentist will cut the gingival tissue away from the tooth to expose the alveolar bone. The dentist may remove some of the gingival tissue and/or bone from around the tooth to expose the additional structure needed to adequately support the crown. 50. Respondent's clinical record for June 18, 2013, did not indicate a diagnosis to support the performance of a crown lengthening procedure on that date. 51. Respondent's clinical record for June 18, 2013, did not otherwise indicate that a crown lengthening procedure was performed on that date. COUNT I 52. Petitioner re-alleges and incorporates paragraphs one (1) through three (3), eleven (11), and thirty-seven (37) through forty-four (44), as if fully set forth herein. 53. Section 466.028(1)(I), Florida Statutes (2012), states that “[m]aking deceptive, untrue, or fraudulent representations in or related to the practice of dentistry[,]” shall constitute grounds for disciplinary action by the Board of Dentistry. 54, Respondent violated Section 466.028(1)(1), Florida Statutes, by making a deceptive, untrue, or fraudulent representation that he performed alveoloplasty on or about May 28, 2013, in conjunction with the extractions of four or more teeth or tooth spaces, per quadrant, in each of the four quadrants of Patient A.K.'s mouth. COUNT II 55. Petitioner re-alleges and incorporates paragraphs one (1) through twenty-two (22), twenty-four (24) through twenty-five (25), twenty-seven (27) through thirty (30), and forty-five (45) through fifty-one (51), as if fully set forth herein. 56. Section 466.028(1)(m), Florida Statutes (2012), states that “[flailing to keep written dental records and medical history records " justifying the course of treatment of the patient [...],” shall constitute grounds for disciplinary action by the Board of Dentistry. 57. Respondent violated Section 466.028(1)(m), Florida Statutes, in one or more of the following ways: A. By failing to keep a written dental record justifying his performance of a gingival flap procedure on or about May 21, 2013; B. By failing to keep a written dental record justifying his performance of a full mouth debridement on or about May 28, 2013; C. By failing to keep a written dental record justifying his performance of comprehensive orthodontic treatment of the adult dentition on or about May 28, 2013; D. By failing to keep a written dental record justifying his performance of the extraction teeth with completely bony impaction with unusual surgical complications on or about May 28, 2013; and/or E. By failing to keep a written dental record justifying his performance of a crown lengthening procedure on or about June 18, 2013. COUNT III 58. Petitioner re-alleges and incorporates paragraphs one (1) through five (5), eleven (11), and twenty-three (23) through thirty-six (36), as if fully set forth herein. 59. Section 466.028(1)(x), Florida Statutes (2012), states that “[b]eing 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[,]” shall constitute grounds for disciplinary action by the Board of Dentistry. 60. Respondent violated Section 466.028(1)(x), Florida Statutes, in one or more of the following ways: A. By failing to accurately diagnose Patient A.K.’s dental condition before proceeding with extractions; and/or B. By failing to recognize that the roots of Patient A.K.’s tooth number 17 were not intact upon extraction. WHEREFORE, Petitioner respectfully requests that the Board of Dentistry enter an order imposing one or more of the following penalties: 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 Board deems appropriate. PCP: May 1, 2015 PCP Members: C.M., T.M., R.P. SIGNED this 4** day of Vic Lia 2015. John H. Armstrong, MD, FACS Surgeon General & Secretary Buce t Yo DWiclavinede Bridget*K. McDonnell Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Florida Bar #99874 TEL: 850.245.4444, FAX: 850.245.4681 Express Mail Address: 2585 Merchants Row, Suite 105 Email: Bridget.McDonnell@flhealth.gov FILED DEPARTMENT OF HEALTH DEPUTY CLERK DOH vy. Anatoly Ripa, D.D.S., Case # 2013-15361 [3 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. DOH vy. Anatoly Ripa, D.D.S., Case # 2013-15361 14

Docket for Case No: 18-006758PL