STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
STATE OF FLORIDA, DEPARTMENT ) OF PROFESSIONAL REGULATION, )
)
Petitioner, )
)
vs. ) CASE NO. 79-2534
)
FRANCES B. GLENN, D.D.S., )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, William E. Williams, held a public hearing in this cause on February 7, 8 and 14, 1980, in Miami, Florida.
APPEARANCES
For Petitioner: Joseph R. Boyd, Esquire
Post Office Box 10369 Tallahassee, Florida 32302
For Respondent: Edward C. Vining, Jr., Esquire and
Richard A. Burt, Esquire
527 Ingraham Building
25 Southeast Second Avenue Miami, Florida 33131
By Administrative Complaint dated December 26, 1979, and filed with the State of Florida, Division of Administrative Hearings on January 15, 1980, the State of Florida, Department of Professional Regulation ("Petitioner") charged Frances B. Glenn, D.D.S. ("Respondent") with various violations of Chapter 466, Florida Statutes, and Chapter 21G-9, Florida Administrative Code, allegedly arising from Respondent's practice of dentistry. In Count I of the Administrative Complaint Petitioner charges that Respondent permitted unlicensed persons in her employ to practice dentistry or dental hygiene, or aided or advised those persons to practice dentistry or dental hygiene contrary to the provisions of Chapter 466, Florida Statutes, and Rules promulgated pursuant thereto. In Count II of the Administrative Complaint, Petitioner charges Respondent with numerous instances of physical mistreatment of children patients. Respondent denied the material allegations of the Administrative Complaint and requested an administrative hearing pursuant to Section 120.57(1), Florida Statutes. Thereafter, Petitioner requested that a Hearing Officer from the Division of Administrative Hearings be assigned to conduct the final hearing in this cause.
At the final hearing, Petitioner called Dr. Bruce Mahaffey, Dr. David Ehrenreich, Annabelle Winnan, Dr. Clement Hill, Sandra Novotney, Tonya Fogg, Mary Pelaez and Victoria Beggins as its witnesses. Petitioner offered
Petitioner's Exhibits 1, 10 and 11, which were received into evidence. Petitioner's Exhibit 2, for identification only, and Petitioner's Exhibit 3, for identification only, were not received into evidence. Respondent testified in her own behalf, and called Virginia McCoy, Cheryl Pyka, Mark J. Fogg, Dr. Neil Powell, Barry Siegel, Karen Siegel, Dr. Samuel Morrow, Maureen Harrison, Annette Gruber, Mildred Andrews, Bertina Roberts, Nilda Ruiz, Darlene MacDonnnell, Mary Elizabeth Young, Dr. Robert McKey, and Dr. Walter E. MacDonnell as her witnesses. Respondent offered Respondents Exhibits 3, 12, 13, 14, 15, 38, 50,
51, 52, 53, 57, and 71 through 85, inclusive, all of which were received into evidence.
FINDINGS OF FACT
At all times material hereto, Respondent was a dentist authorized to practice dentistry in the State of Florida, with offices located at 7900 Red Road, Miami, Florida. In her practice, Respondent specialized in pedodontics and orthodontics. At various times during her practice, Respondent employed Annabelle Winnan, Sandra Novotney, Mary Ellen Pelaez and Tonya Fogg as dental assistants. Duties and responsibilities allegedly delegated by Respondent to these employees are the subject matter of the allegations contained in Count I of the Administrative Complaint filed herein.
Annabelle Winnan was employed in Respondent's dental office from October 11, 1966 through January 1, 1969, and again from July 15, 1974 through July 1, 1977. During the terms of her employment, Ms. Winnan received on-the- job training from Respondent, and in September of 1974, Ms. Winnan attended a formal training course for expanded duties for dental auxiliaries at Lindsay Hopkins Technical Education Center in Miami, Florida. In September of 1974, Ms. Winnan received a certificate from Lindsay Hopkins certifying her to perform expanded duties as a dental auxiliary. However, at no time prior to or during the terms of her employment with Respondent did Ms. Winnan ever receive any formal education as a dental hygienist, nor was she ever certified or licensed as a dental hygienist in the State of Florida.
The allegations in Count I of the Administrative Complaint dealing with duties performed by Ms. Winnan relate solely to her second term of employment with Respondent from July 15, 1974 through July 1, 1977. In the Administrative Complaint, Petitioner alleges that Ms. Winnan, at the direction of Respondent, routinely "scaled" and polished patients' teeth; took alginate impressions for both study models and appliances; was directed to place and adjust these applicances in patients' mouths; was directed to fit and cement orthodontic bands for patients and to recement loose bands, even in the absence of an emergency; and routinely took dental X-rays, including cephalostat, cephalogram, panorex, and regular X-rays.
Ms. Winnan left Respondent's employ January 1, 1969, because Respondent closed her practice due to ill health. When Respondent reopened her practice in July of 1974, Ms. Winnan returned to work for her, and was, for a time, Respondent's only employee. During the period of time from July 15, 1974 through September, 1974, when Ms. Winnan obtained her expanded duties certificate, Ms. Winnan, at Respondent's direction, routinely took both panorex X-rays and bite-wing radiographs of Respondent's patients. (T. 440). In addition to taking the X-rays, Ms. Winnan would develop those X-rays and submit them to Respondent for reading.
In addition, during the period between July, 1974, and September, 1974, when Ms. Winnan received her expanded duties certificate, at the direction of
Respondent she cleaned and polished the clinical crowns of the teeth of many of Respondent's patients, for the purpose of removing stains and other foreign matter. In addition, during this period Ms. Winnan used a metal instrument known to her as a "scaler" in the course of her cleaning and polishing patients' teeth. Ms. Winnan's use of the "scaler" was limited to the clinical crown of the patient's teeth, or that area above the gum line of the tooth. It is unclear from the record whether Ms. Winnan's activities in this regard constituted "scaling", as that term is commonly used in the dental profession.
It is, however, clear that she used the instrument frequently at Respondent's direction.
Ms. Winnan's activities with respect to the taking of X-rays, and cleaning and polishing the teeth of Respondent's patients continued, in the fashion indicated above, from the time Ms. Winnan received her expanded duties certificate through the time she left Respondent's employ in July of 1977.
It appears from the record in this proceeding that Ms. Winnan also took alginate impressions of the mouths of Respondent's patients for study and diagnostic models both before and after she received her expanded duties certificate in September of 1974. However, although Ms. Winnan also testified that she took alginate impressions from which "Hawley" appliances were made for Respondent's patients, she was unable to identify the names of any such patients, the dates the impressions were taken, or the circumstances surrounding the taking of the impressions. Further, there is no showing in the record in this proceeding that any casts taken by Ms. Winnan were used for the fabrication of a Hawley appliance or any other appliance designed to be worn in the human mouth. Significantly, there is no showing in the record of Respondent's office practice during this period concerning how the impression was handled after it was taken to corroborate Ms. Winnan's assertion that impressions taken by her were ultimately fabricated into appliances for Respondent's patients. In addition, although the evidence establishes that Ms. Winnan took impressions for mouth study casts of Respondent's patients prior to receiving her expanded duties certificate, there is insufficient evidence on which to base a finding that these impressions were taken without the direct supervision of Respondent, or that the Respondent did not examine the patient's mouth prior to and following the taking of the impressions.
Count I of the Administrative Complaint also charges, in part, that Respondent directed Ms. Winnan " . . . to place and adjust . . . appliances in .
. . patients' mouth[s] ." Although there is some testimony in the record to show that Ms. Winnan on occasion "placed" appliances in patients' mouths, there is no showing that the simple act of "placing" such an appliance requires any special expertise, nor is there any showing that the doctor was not present and directly supervising Ms. Winnan's activities in this regard. With regard to the alleged "adjustment" of appliances by Ms. Winnan, there is no testimony to indicate the nature of these alleged "adjustments", nor is there any testimony to show that Respondent was not present and supervising any such activity, even assuming that it did occur.
Although Respondent did no major orthodontics work until some time during 1977, she did engage in some isolated orthodontic work during the time of Ms. Winnan's employment. This orthodontic work included the utilization of orthodontic bands to accomplish movement in patients' teeth. The process of installing bands on patients' teeth included "pre-sizing", or selecting the appropriate band size, "contouring" or festooning" the band to fit the contour of the tooth, placing cement in the band and, finally, placing the band on the tooth. The evidence establishes that during her second period of employment
from 1974 through 1977, Ms. Winnan "pre-sized" orthodontic bands, at times when Respondent was in another room, placed cement in the bands, and placed the bands on the patients' teeth. After the bands were installed by Ms. Winnan, the Respondent would customarily check Ms. Winnan's work before discharging the patient.
During a period in the months of June and July, 1977, Respondent took leave from her dental office to vacation in Spain. During Respondent's absence from her office, Ms. Winnan was assigned by Respondent to dispense orthodontic appliances to Respondent's patients, which appliances had earlier been prescribed by Respondent. In addition, Ms. Winnan was directed to dispense elastics for, use with orthodontic appliances to certain of Respondent's patients. However, during Respondent's absence from her office Ms. Winnan resigned her position with Respondent without having dispensed any orthodontic appliances or elastics.
After Respondent returned from vacation and discovered that Ms. Winnan had resigned, Respondent filed a lawsuit against Ms. Winnan for breach of an alleged oral employment contract. This lawsuit was eventually resolved in favor of Ms. Winnan. However, Ms. Winnan testified that she would probably not have complained to the Board of Dentistry about Respondent's delegation of duties to her in the absence of the lawsuit.
Sandra Novotney was employed in Respondent's dental office from October 10, 1976 through June, 1977; again during the months of August and September of 1977; and, finally, from December of 1978 through June of 1979. At various times Miss Novotney's duties included both secretarial work and chair- side assistance to Respondent. Miss Novotney has never received any formal training as either a dental hygienist or dental auxiliary, either prior to or during the time of her employment with Respondent, nor has she ever received licensure or certification as a dental hygienist or a dental auxiliary. Count I of the Administrative Complaint, in part, charges that while Ms. Novotney was employed with Respondent, Respondent directed her to " . . . routinely [take] impressions for both study casts and appliances that were used for patients . .
." and " . . . routinely [adjust] and [fit] orthodontic bands for patients, and [place] arch wires on patients."
During her second period of employment with Respondent, Ms. Novotney took alginate impressions of the mouths of certain of Respondent's patients. In her testimony at the final hearing Ms. Novotney was unable to recall the names of any patients from whom she took impressions or the dates that those impressions were taken. It appears from the record that orthodontic appliances made from impressions taken of Respondent's patients' mouths were not fabricated in Respondent's office, but that impressions were mailed to a laboratory for fabrication of appliances. Accordingly, absent a demonstrated knowledge of the office procedures concerning the handling of these impressions once taken, it would be difficult, if not impossible, to determine the purpose for which these impressions were used. In this connection, Ms. Novotney gave no testimony concerning the handling of the impressions taken by her after they were removed from the mouths of the patients, instead flatly stating that the impressions were used for the fabrication of appliances. Given Ms. Novotney's testimony, which was uncorroborated by any other evidence and was denied by Respondent, there is insufficient evidence in the record in this proceeding upon which to base a conclusion that any impressions taken by Ms. Novotney were used to fabricate appliances to be worn in the human mouth. In addition, Ms. Novotney's testimony concerning the taking of impressions failed to establish that impressions taken for study casts were taken without the direct supervision of
Respondent, or that the Respondent did not examine the patient's mouth prior to and following the taking of the impressions.
During her third period of employment with Respondent, Respondent would, on occasion, allow Ms. Novotney to "pre-size" orthodontic bands by placing them on a patient's tooth. In addition, Ms. Novotney, at Respondent's direction, cemented orthodontic bands on a patient's tooth by placing the band on the tooth and having the patient bite down on a flat instrument in order to correctly seat the band. Ms. Novotney accomplished this procedure only with Respondent's presence in the office, although Respondent would, on occasion, not be physically present in the operatory when Ms. Novotney was actually cementing the band. However, Respondent routinely checked the patients on whom Ms. Novotney cemented bands before the patient was discharged.
Although it is alleged in the Administrative Complaint that Ms. Novotney routinely "adjusted" orthodontic bands at Respondent's direction, it is clear from the testimony in this proceeding that Ms. Novotney never made any adjustment to orthodontic bands.
Orthodontic bands are often connected by arch wires in order to provide the torque necessary to achieve the desired tooth movement. After bands are placed on a patient's teeth, an arch wire must be pre-sized and cut to fit the patient's mouth, and then must be threaded through brackets located on the orthodontic bands and finally secured. It appears from the evidence in this proceeding that Ms. Novotney, at Respondent's direction, placed arch wires in patients' mouths and secured them in place by putting an elastic band around the arch wire and around the orthodontic band cemented to the tooth. Ms. Novotney's duties with respect to placing and securing arch wires occurred during her third period of employment with Respondent.
In addition to her other duties outlined above, it also appears from the record that Ms. Novotney polished or cleaned the clinical crowns of patients' teeth, and polished at least one amalgam restoration during her employment by Respondent. Respondent was not, however, charged in the Administrative Complaint with allowing Miss Novotney to perform these procedures, and no action will, therefore, be recommended against Respondent in this Recommended Order in connection with this activity.
Mary Ellen Pelaez was employed in Respondent's dental office from August of 1977 through March of 1979. During her employment with Respondent, Ms. Pelaez attended the expanded duties course at Lindsay Hopkins Technical Education Center. Ms. Pelaez received her extended duties certificate from Lindsay Hopkins in August of 1978. At no time material hereto was Ms. Pelaez ever licensed or certified as a dental hygienist in the State of Florida.
In the Administrative Complaint, Petitioner charges that Ms. Pelaez, while not under the direct supervision of Respondent, ". . . routinely took impressions for study casts and appliances; polished, cleaned, and scaled teeth; selected, pre-sized, and cemented-orthodontic bands."
During the time she was employed by Respondent, Ms. Pelaez, at Respondent's direction, took alginate impressions of Respondent's patients' mouths for the purpose of making study casts, retainers and appliances. Ms. Pelaez would pour the impressions, cut them down, and Respondent would mark the impression for fabrication of an appliance or a retainer, and the impression would then be mailed to a laboratory for fabrication. After Ms. Pelaez had taken the impression, and after Respondent had marked it appropriately, a note
would be placed with the impression indicating whether Respondent wished a retainer or an appliance made for the patient from the impression.
During the time she was employed by Respondent, Ms. Pelaez both before and after she received her expanded duties certificate, cleaned and polished the clinical crowns of the teeth of many of Respondent's patients for the purpose of removing stains and other foreign matter. To accomplish this task, Ms. Pelaez used an electronically-run instrument and applied pumice paste to the teeth with a rubber cup. In addition, Ms. Pelaez used an instrument known to her as a "scaler", to assist in removing foreign matter from patients' teeth. Respondent often would not be in the operatory with Ms. Pelaez and the patient while the cleaning and polishing of the patient's teeth was occurring, but Respondent would, in most instances, check the patient's mouth after the procedure was performed by Ms. Pelaez. At some point after she received her expanded duties certificate, Ms. Pelaez advised Respondent that she felt that she could not legally continue to "scale" teeth. Respondent replied that as long as Ms. Pelaez was working for her she would do as she was instructed.
In addition to the aforementioned duties, during her employment with Respondent, both before and after she received her expanded duties certificate, Ms. Pelaez, at the direction of Respondent, selected, pre-sized, and cemented orthodontic bands on the teeth of many of Respondent's patients. In many cases, while Ms. Pelaez was selecting and cementing these orthodontic bands, Respondent was not physically present in the operatory with her to directly supervise these activities. However, it appears from the evidence, that Respondent routinely examined these patients after the bands were cemented by Ms. Pelaez.
Ms. Pelaez was discharged by Respondent in March of 1979. Ms. Pelaez filed a claim for unemployment compensation, which claim was contested by Respondent, who claimed that Ms. Pelaez was fired for "insubordination." The unemployment compensation claim was apparently resolved in favor of Ms. Pelaez.
Tonya Fogg was employed in Respondent's office from January 2, 1979 through October 31, 1979. At no time, either prior to or during her employment with Respondent, did Ms. Fogg receive any formal training either as a dental auxiliary or a dental hygienist, nor was she ever licensed or certified as a dental auxiliary or a dental hygienist in the State of Florida. Count I of the Administrative Complaint charges, in part, that Ms. Fogg, at Respondent's direction, ". . . routinely took impressions for study casts and appliances, selected, pre-sized, and inserted orthodontic bands; and adjusted and placed arch wires . . ."
The evidence in this proceeding establishes that, during the period of her employment in Respondent's office, Ms. Fogg, at Respondent's direction, took alginate impressions of the teeth of many of Respondent's patients for the purpose of making study models and for the fabrication of retainers or positioners. After Ms. Fogg took these impressions, she would place them in a box for mailing to a laboratory for fabrication, and was directed by Respondent to write a prescription for inclusion with the impression asking that either a retainer or positioner be prepared by the laboratory.
Ms. Fogg was also on numerous occasions directed by Respondent to select, contour and cement orthodontic bands on the teeth of many of Respondent's patients. Respondent had instructed Ms. Fogg and other dental assistants employed in her office in the use of a "Mizzy stone," a heatless stone used to contour or "festoon" orthodontic bands to fit a patient's tooth.
Procedures of this nature performed by Ms. Fogg were often accomplished without the presence of Respondent in the operatory.
In addition, Ms. Fogg, and other dental assistants employed in Respondent's office, selected, pre-sized, installed and removed arch wires used in the mouths of some of Respondent's patients. These procedures were performed by Ms. Fogg at Respondent's direction, and included making the proper determination as to arch form and symmetry, and the performance of final adjustments on the arch wire.
Ms. Fogg is apparently a close personal friend of Ms. Pelaez. As indicated above, Ms. Pelaez filed an unemployment compensation claim after she was discharged from Respondent's employ Ms. Fogg resigned from her position with Respondent on October 31, 1979, and the next day appeared as a witness on behalf of Ms. Pelaez at a hearing on Ms. Pelaez' unemployment compensation claim.
In Count II of the Administrative Complaint, Respondent is charged with various types of physical mistreatment of the following patients: John
(last name and age unspecified); Jeff Heggins (age 4); Craig Beggins (age 10); Edwin Rivera (age 3-1/2); Shana Hornwhite (age unspecified) Terry Ruiz (age unspecified) ; Eric Lumkin (age unspecified); Gregory Roberts (age 7); Catherine Gruber (age 12); and Gary Andrews (age unspecified). The incidents involving these patients are alleged to have occurred during a period from "approximately" October of 1976 through October of 1979.
At all times material hereto, Respondent's cumary office practice was to have parents of her children patients wait in the office reception area while procedures were performed on the patients in an operatory separated from the reception area by a locked door. As a result, the only potential eye witnesses to most instances of alleged physical mistreatment of patients were the patients themselves, Respondent's dental assistants, and the Respondent.
None of the patients who were allegedly mistreated by Respondent were called as witnesses. Respondent categorically denied having in any way mistreated the patients as alleged in the Administrative Complaint, instead contending that the most that had ever occurred was the use of "behavioral management" techniques commonly recognized in the dental profession. However, Ms. Winnan, Ms. Pelaez and Ms. Fogg each testified that they had personally observed various of the alleged incidents of physical mistreatment.
Ms. Winnan testified that at some time between June of 1976 and July of 1977, during the course of Respondent's treatment of a patient named "John", whose last name Ms. Winnan could not remember, the child began to cry. In an effort too stop the child from crying, Ms. Winnan testified that Respondent placed her hand over the child's nose and mouth until he stopped crying, but that when Respondent removed her hand, the child again began to cry, whereupon Respondent slapped him across the face. When the child still persisted in crying, Ms. Winnan testified that Respondent stuck her finger down the child's throat and that when Respondent removed her finger it was covered with blood. Ms. Winnan did not report this incident to the parents of the child, nor to the Board of Dentistry until two to three years after it had occurred. Respondent denies that the incident ever occurred and, given Ms. Winnan's inability to more fully identify the child or the date on which the incident is alleged to have occurred, it is hard to conceive how Respondent could do much more than that to defend against these allegations. Although Ms. Winnan's testimony regarding this incident is not incredible, it is no more credible than Respondent's denial of the incident. Accordingly, there is insufficient evidence in the record of
this proceeding on which to base a finding of fact that the incident occurred as alleged.
On December 1, 1978, Respondent was treating a patient named Jeffrey Beggins. In the course of her treatment of this patient, Respondent slapped Jeffrey Beggins' face with sufficient force to leave a reddened handprint. The reason or reasons for Respondent having slapped the child are not clear from the record. This incident was witnessed by Ms. Pelaez. On the same day that this incident occurred, Respondent advised Ms. Pelaez that Respondent had received a call from Jeffrey Beggins' mother complaining about the slapping incident. Respondent advised Ms. Pelaez that the child's mother had been invited to come to the office for a conference, and that when the child's mother came into the office, Ms. Pelaez should advise the mother that the slapping incident had never occurred. The child's mother did not keep the office conference with Respondent, but did not return her children to Respondent for treatment thereafter. Mrs. Beggins' testimony at the final hearing in this cause regarding her telephone conversation with Respondent is consistent with Respondent's recollection of the subject matter discussed between them.
There is insufficient credible evidence in the record in this proceeding to establish that Respondent physically mistreated or abused Craig Beggins, Shana Hornwhite, Terry Ruiz, Eric Lumkin, Catherine Gruber or Gary Andrews. There was no testimony elicited at the final hearing in this cause concerning the allegations in Count II of the Administrative Complaint with respect to mistreatment or abuse of patients Edwin Riviera or Gregory Roberts.
Respondent possesses an extraordinary record of academic accomplishment in the field of dentistry. In addition, she enjoys a very good reputation in both the medical and dental communities in Dade County, Florida.
There were numerous and profound conflicts in the testimony of several of the witnesses testifying in this proceeding. In attempting to resolve these conflicts, the Hearing Officer took into account the appearance, demeanor and manner of the witnesses while testifying, their interest, if any, in the outcome of this proceeding, and the consistency of their testimony with the testimony of other witnesses regarding the facts at issue herein.
Both Petitioner and Respondent have submitted proposed findings of fact for consideration by the Hearing Officer. To the extent that these proposed findings of fact have not been incorporated in this Recommended Order, they have been rejected as either not having been supported by the evidence, or as being irrelevant to the issues decided herein.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction of the parties to and the subject matter of this action. Section 120.57(1), Florida Statutes.
Section 466.028(1), Florida Statutes, in pertinent part, empowers the Board of Dentistry to take disciplinary action against a licensee upon a finding of guilt of any of the following acts:
* * *
(g) Aiding, assisting, procuring, or advising any unlicensed person to prac- tice dentistry or dental hygiene contrary
to this chapter or to a rule of the department or the board.
* * *
(u) Fraud, deceit, or misconduct in the practice of dentistry or dental hygiene.
* * *
Section 466.24, Florida Statutes, authorizes the revocation or suspension of a dentist's license when it is established that the licensee:
* * *
(3) Has been guilty of:
* * *
(e) Employing or permitting any unlicensed person to perform any work
in his office which would constitute the practice of dentistry or dental hygiene, except a dental auxiliary pursuant to the provisions of this chapter ....
Rule 21G-9.02, Florida Administrative Code, provides that a dental auxiliary with "on the job training" may perform the following tasks under the supervision of a licensed Florida dentist:
Take and record case history, pulse, blood pressure and oral temperature.
The topical application of fluorides to the exposed surface of teeth.
Apply oxygenating agents in the oral cavity, not in excess of ten volume U.S.P., not to include endodontic therapy.
Instruct and supervise oral hygiene care.
Insert temporary medicinal fillings using hand instruments only.
Rule 21G-0.01, Florida Administrative Code, defines "on the job training" as
. . . training in a Florida licensed den- tist's office holding a current annual renewal certificate, and such on the job training is the legal and moral responsi- bility of the dentist who trains the auxiliary, or training in a school approved by the Board to teach expanded duties of auxiliary personnel.
Rule 21G-9.03, Florida Administrative Code, permits a dental auxiliary with on-the-job training under the direct supervision of a licensed Florida dentist to perform the following tasks, so long as the patient's mouth is examined by the dentist immediately prior to and following performance of the task:
Take impressions-for complete mouth study casts using irreversible
hydro-colloide. This cast may not be used for the fabrication of any appli- ance designed to be worn in the human mouth.
The topical application in the oral cavity of silver nitrate, anti- inflammatory agents, astringents, and topical anesthetics, excluding aerosol sprays.
Place and remove rubber dam.
Remove excess cement from dental restorations and orthodontic appliances.
Remove sutures, excluding wire sutures, and extra oral sutures.
Insert and remove dressings from alveolar sockets in postoperative osteitis. (In cases of an emergency, an auxiliary
may perform this task without pre-examina- tion by a dentist.)
Place and remove periodontal dressings. (In cases of an emergency an auxiliary may perform this task without pre-examination by a dentist.)
Cement temporary crowns and bridges utilizing temporary cement. (In cases of an emergency, an auxiliary may perform this task without pre-examination by the dentist.)
Rule 21G-9.04, Florida Administrative Code, allows a dental auxiliary who has received Board-approved formal training" to perform the following tasks under the supervision of a licensed Florida dentist:
Polish the clinical crowns of the teeth for the purpose of removing stains. The existing contour of the tooth must not be changed and instrumentation shall be limited to rubber cups, bristle brush, port polishers, and polishing materials.
A dental auxiliary [sic] may polish amalgam restorations.
"Formal training" is defined in Rule 21G-9.01, Florida Administrative Code, as
. . . training by a Board approved school and requires all schools in Florida desiring to teach expanded duties of auxiliary per- sonnel to submit to the Board an outline
of their proposed curriculum, staff and equipment, and approval of courses requiring formal training prior to the implementation and establishment and approval of these courses.
Rule 21G-9.05, Florida Administrative Code, permits a dental auxiliary who has received Board-approved formal training to perform the following tasks
under the direct supervision of a licensed Florida dentist, so long as the patient's mouth is examined by the dentist immediately prior to and following performance of the task:
Place and remove matrices.
Obtain bacteriological cytological specimens, involving no cutting of the tissue [sic] and not to include endodontic cultures.
Expanded duties of the auxiliary:
Select and pre-size orthodontic
bands, which includes selection of the proper size band for the tooth to be banded, but does not include or involve any adapting, contouring, trimming or otherwise modifying the band material so as to constitute fitting of the band which must be performed by the dentist.
In case of emergency, remove and
re-cement loose bands if they have proper contour and fit and are not permanently attached to any applicance [sic]. Emergency, as used herein, is a condition which exists only when the dentist is unable to be physically present to pre-examine the patient.
Select and pre-size archwires
prescribed by the dentist for final adjustment and placement by the dentist. Once the wire prescribed by the dentist is sized accurately and marked, only the dentist may make final adjustment bends, arch form determination and check for symmetry prior to final placement
by the dentist.
Secure and/or unsecure an archwire by means of attaching and/or removing the fastening device. In am emergency, as de- fined hereinabove, this can be performed by an auxiliary without pre-examination by the dentist. The arch wire is to be placed by the dentist only.
Select by preselection or premeasure- ment extraoral appliances. The appliance must be prescribed by the dentist and the final fit and adjustment performed by the dentist.
Place or remove pretreatment sep- arators as prescribed by the dentist.
Section 466.028(2), Florida Statutes, authorizes the Board of Dentistry, upon finding a licensee guilty of any of the acts proscribed by Section 466.028(1), Florida Statutes, to impose one or more of the following penalties:
Denial of an application for licensure.
Revocation or suspension of a license.
Imposition of an administrative
fine not to exceed $1,000 for each count or separate offense.
Issuance of a reprimand.
Placement of the licensee on probation for a period of time and subject
to such conditions as the board my specify, including requiring the licensee to attend continuing education courses or demonstrate his competency through a written or practical examination or to work under the supervision of another licensee.
Restricting the authorized scope of practice.
Petitioner bears the burden in this proceeding of proving the allegations contained in the Administrative Complaint by the preponderance of the evidence. Gans v. Department of Professional and Occupational Regulation, Case No. 79-186 (Fla. 3rd DCA April 29, 1980); Fitzpatrick v. City of Miami Beach, 328 So.2d 578 (Fla. 3rd DCA 1976),
With respect to the allegations contained in Count I of the Administrative Complaint it is specifically concluded that, in light of the foregoing Findings of Fact, Respondent has violated Sections 466.028(1) and 466.24, Florida Statutes, and the above-quoted rules promulgated pursuant thereto, by aiding, assisting, procuring, advising, employing or permitting an unlicensed person to perform work in her office which work constituted the practice of dentistry or dental hygiene, and by allowing dental auxiliaries to perform tasks not permitted under the rules of the Board of Dentistry. These violations consisted of Respondent's directing and allowing Annabelle Winnan to clean and polish the clinical crowns of teeth before obtaining a certificate authorizing her to perform expanded duties; directing and allowing Ms. Winnan to use a "scaler" in the course of cleaning and polishing the clinical crowns of teeth; by directing and allowing Ms. Winnan to pre-size and cement orthodontic bands on the teeth of Respondent's patients; by directing and allowing Sandra Novotney to pre-size and cement orthodontic bands on the teeth of Respondent's patients; by directing and allowing Sandra Novotney to place and secure arch wires in the mouths of Respondent's patients; by directing and allowing Mary Pelaez to take alginate impressions for making retainers and appliances to be worn in the mouths of Respondent's patients; by directing and allowing Ms. Pelaez to clean and polish the clinical crowns of the teeth of Respondent's patients before Ms. Pelaez received a certificate to perform expanded duties; by directing and allowing Ms. Pelaez to pre-size and cement orthodontic bands on the teeth of Respondent's patients; by directing and allowing Tonya Fogg to take alginate impressions of the mouths of Respondent's patients for the fabrication of appliances to be worn in those patients' mouths; by directing and allowing Ms. Fogg to pre-size and cement orthodontic bands on the teeth of Respondent's patients; and by directing and allowing Ms. Fogg to remove, pre-size and install arch wires in the mouths of Respondent's patients.
With respect to the allegations contained in Count II of the Administrative Complaint, it is specifically concluded that Respondent has violated the provisions of Section 466.028(1)(u), Florida Statutes, which prohibits misconduct in the practice of dentistry by striking a patient, Jeffrey Beggins, across the face in the course of administering dental care.
RECOMMENDED ORDER
Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED:
That a Final Order be entered by the Department of Professional Regulation imposing an administrative fine of $1,000 and suspending the license of Respondent, Frances B. Glenn, for a period of six months from the date of final agency action with regard to the violations contained in Count I of the Administrative Complaint specifically set forth above, and dismissing the remainder of the allegations contained in Count I.
That a Final Order be entered by the Department of Professional Regulation imposing an additional administrative fine of $1,000 and suspending the license of Respondent, Frances H. Glenn, for a period of six months from the date of final agency action, with regard to the violations contained in Count II of the Administrative Complaint set forth above, such suspension to run concurrently with the suspension recommended under Count I of the Administrative Complaint, and that the remaining allegations of Count II of the Administrative Complaint which were not proven in this proceeding be dismissed.
RECOMMENDED this 16th day of June, 1980, in Tallahassee, Florida.
WILLIAM E. WILLIAMS
Hearing Officer
Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301
(904) 488-9675
COPIES FURNISHED:
Joseph R. Boyd, Esquire Post Office Box 10369 Tallahassee, Florida 32302
Edward C. Vining, Jr., Esquire and
Richard A. Burt, Esquire
527 Ingraham Building
25 Southeast Second Avenue Miami, Florida 33131
| Issue Date | Proceedings |
|---|---|
| Nov. 21, 1980 | Final Order filed. |
| Jun. 16, 1980 | Recommended Order sent out. CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Oct. 06, 1980 | Agency Final Order | |
| Jun. 16, 1980 | Recommended Order | Recommend suspension and fine for aiding unlicensed practice and mistreating child patients. |
