STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

HABIB H. GHAHREMANNEZHAD, D.M.D., )

)

Petitioner, )

)

vs. ) CASE NO. 83-1550

)

DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF DENTISTRY, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, a hearing was held in this case before Arnold H. Pollock, a Hearing Officer with the Division of Administrative Hearings, in Tallahassee, Florida, on October 6, 1983. The issue for determination was whether Petitioner was awarded a proper grade on his work in the practical examination of the Board of Dentistry in December, 1982.

APPEARANCES

For Petitioner: Habib H. Ghahremannezhad, D.M.D., pro se 2127 Audubon Street, #91

Thibodaux, Louisiana 70301

For Respondent: Frank Vickory, Esquire

Department of Professional Regulation

130 North Monroe Street Tallahassee, Florida 32301

INTRODUCTION

By formal notice dated February 4, 1983, Petitioner was notified by Respondent that he had failed to achieve a passing score on the Dental Mannequin Examination administered by Respondent on December 15 and 16, 1982. After the examination, Petitioner was afforded the opportunity to have an examination review with a member of the Board to go over the procedures for which he was given a failing grade. This was done. Respondent thereafter took exception with the grade awarded and requested a formal hearing by letter dated April 25, 1983. The hearing was originally scheduled for July 15, 1983, but upon request of both parties was rescheduled for October 6, 1983, when held.

At the hearing, Petitioner testified in his own behalf and introduced Petitioners' Exhibit 1. Respondent introduced the testimony of Dr. Michael F. Agnini and Respondent's Exhibits A and B.

FINDINGS OF FACT

1. During the summer of 1982, Petitioner, Habib H. Ghahremannezhad, of Thibodaux, Louisiana, sent a letter to the Respondent requesting information on

   the requirements to take the Florida dental examination. He had been advised by a representative of the American Dental Association that foreign dentists could take the examination. 1/ In response to his letter, the Respondent sent him the required application forms, which had a submission deadline in late September, 1982. Petitioner submitted them on time as required; and just a few weeks before the examination, in November, 1982, he received further instructions from Respondent which included the requirement that he, the candidate, bring with him to the examination a stipulated number of real human teeth in what could be described as perfect shape.

   
   

2. Teeth of this nature are difficult to get; and though Petitioner called many practicing dentists in the area where he lived and also contacted the local dental school, he was unable to procure the appropriately preserved teeth within the short period of time between his receipt of notification of the requirement and the test. As a result, he was required to purchase a human skull from a medical supply house, from which he extracted the required teeth. These skulls are prepared for use by medical students and are dried out. The teeth in them, therefore, are brittle and fragile. Though he stored them in a glycerine/water solution up to the examination, this could not and did not restore already dehydrated, dead, brittle teeth to their former condition. The appropriate teeth would have been freshly extracted and thereafter stored in a mixture of glycerine and water which would have preserved their resiliency and rendered them not brittle and subject to easy breakage. There was no evidence presented, however, to show that Petitioner received his instructions any later than other candidates who suffered under the same handicaps as he in procuring appropriate teeth. In fact, he admits he was not singled out for late instructions, and the other candidates had the same problems.

   
   

3. The mannequin examination consisted of at least nine different procedures. Each procedure was performed by the candidate with a monitor in the area. When the procedures were completed, they were thereafter graded anonymously (each procedure model was marked only with the candidate's examination number, not the name) by three separate examiners who independently, out of the presence of each other (and who were also identified only by a number), assigned a numerical grade to each procedure based on criteria set out on a prepared grading sheet. Under the rules for this examination, a grade of

   3.0 out of a range from 0 to 5 is required to achieve a passing score. Respondent achieved a grade of 2.71, which was a failing grade and which was arrived at by averaging the three grades for each procedure, adding these nine averages and dividing by nine.

   
   

4. Petitioner scored, as follows:

   
   

   (a)	Procedure	01
   	Examiner	003	-	2
   	Examiner	071	-	3	average	2.67
   	Examiner	072	-	3
   (b)	Procedure	02
   	Examiner	072	-	3
   	Examiner	071	-	3	average	3.0
   	Examiner	008	-	3
   (c)	Procedure	03
   	Examiner	072	-	1
   	Examiner	071	-	1	average	0.67
   	Examiner	008	-	0

   
   

   (d)	Procedure	04
   	Examiner	008	-	2
   	Examiner	071	-	1	average	2.0
   	Examiner	072	-	3
   (e)	Procedure	05
   	Examiner	072	-	4
   	Examiner	,071	-	4	average	4.0
   	Examiner	008	-	4
   (f)	Procedure	06
   	Examiner	059	-	5
   	Examiner	066	-	3	average	4.33
   	Examiner	037	-	5
   (g)	Procedure	07
   	Examiner	059	-	3
   	Examiner	066	-	3	average	3.67
   	Examiner	037	-	5
   (h)	Procedure	08
   	Examiner	059	-	3
   	Examiner	066	-	4	average	4.0
   	Examiner	037	-	5
   (i)	Procedure	09
   	Examiner	059	-	0
   	Examiner	066	-	0	average	0.33
   	Examiner	037	-	1

   
   

5. Petitioner makes numerous allegations regarding the fairness of the examination and what he considers to be discrimination against foreign dental students. He produced, however, no evidence save his own opinion to support these claims except in the case of the instructions (Petitioner's Exhibit 1), which, on Page 3 at Paragraph 7, state that a candidate who fails this examination two times will not be eligible to take the remaining examinations for licensure "except for a candidate who graduated from the University of Havana prior to 1962, who may take [this] examination an unlimited number of times." Petitioner claims this provision discriminates against foreign dentists. If any discrimination is shown, it is clearly reverse discrimination in favor of older Cuban dentists, a decision which is an approved policy of the Respondent. Consequently, there is no showing whatever that Petitioner was in any way discriminated against.

   
   

6. Petitioner also contests, however, the grades given him on Procedures 3 and 9. Procedure 3 was a "Dental Class III preparation for a composite restoration on a maxillary central incisor." Here, the tooth Petitioner had for preparation was one of those fragile teeth which had dried out and was brittle. As a result, the tooth broke as he was working on it. At this point, he showed his problem to the monitor, who advised him to include that area in the preparation. He did that, as instructed, and received a low grade on his procedure, which he contends was the fault of the instructions given him by the examiner.

   
   

7. Procedure 3 was designed to test the candidate's ability to demonstrate an acceptable preparation to Respondent's standards. This preparation would be

   a minimal preparation which would be for a very small cavity. Petitioner was graded low on this procedure by all three examiners, who each made additional handwritten comments on the form. All comments related to excessive depth of the preparation, which is not related to the width and size of the preparation. These latter conditions could, indeed, be related to the instructions of the monitor and, if they were the only comments, might justify adjustment. However, Petitioner made his preparation too deep, in fact exposing the pulp (nerve) of the tooth. This defect is not related to the size of the preparation as increased by the instructions of the monitor to include the area in the preparation. By itself, pulpal exposure is sufficient to cause a grade of 0 for this procedure. Here, the groove was so deep and so grossly oversized it went beyond any tolerance which might be given for a situation where, like here, the examinee has no idea, because of the dead tooth and no X rays, how close to the surface the pulp is. Further, two of the three grade sheets bear the notation "SMN," which means "saw monitor's notes." This indicates that before awarding a grade, these two examiners were aware of the problem that Petitioner had and that the monitor had advised him to include the break area in the procedure.

   Even after making allowances for that, two of the examiners graded Petitioner's work as "1," and the other gave him "0." These grades are consistent and within normal deviation, and all are failing grades. In light of this, one cannot conclude the rating for this procedure was improper so as to merit upward adjustment.

   
   

8. As to Procedure 9, this was to prepare a "wax-up for a cast-gold bridge on the above [formerly] prepared teeth. . ." Petitioner contends he did as directed, completed the procedure, and turned it in. In an actual clinical situation, this work would not be done in the mouth of the patient, but for examination purposes, the candidates were directed to make the wax pattern directly in the model-- a far more difficult and rarely done procedure.

   However, the grading criteria take into consideration the conditions under which the examinee has to work in determining a pass or fail grade. This procedure has been changed with the 1983 examination. Candidates will no longer be required to work under this previous, more difficult method.

   
   

9. After Petitioner completed the procedure, he turned it in and left. When the first examiner looked at the device prepared by Petitioner and attempted to take it apart, he broke it. Petitioner was awarded a grade of 0 by two examiners and a "1" by the third. He contends that since his wax model was broken by the first examiner, this was not his fault, and he should not have been given failing grades. He states that when he handed the pattern in, it was intact and, contra to claims of the examiner, he does not believe the pattern broke as a result of the area of cohesion being too small, as this item was graded as passing in the prior procedure. In addition, Petitioner contends that even if the wax cohesion was insufficient, this still does not justify a "0," since there were at least three other major areas which should be considered. However, review of the grading sheets, at least for Examiners 059 and 037, shows that numerous other deficiencies were found in Petitioner's procedure here, aliunde the wax cohesion and breakage, and these other deficiencies would justify a failing grade--even a "0."

   
   

10. In the area of the broken wax pattern, however, examiners are indoctrinated as to all procedures to be tested the day before the examination and go over them thoroughly in advance. As to wax patterns, they are told at this time that the pattern may be removed, but only using "utmost care." Here, the candidate is asked to make a wax pattern for a 3/4 crown for one tooth, the back attachment to be waxed to a full crown. The stability of the pattern to withstand withdrawal is related to how well the procedure is waxed. In the

    opinion of Dr. Agnini, the Respondent's expert, sufficient wax could have been inserted to strengthen the wax pattern as it was being built under exam conditions. The examiner's (059) comments were that he broke the pattern and that the attachment was poor. It was the poor attachment that caused the device to break. Review showed that it was insufficiently waxed (See sheet for 059, Comment 5d.), and this did not meet the criteria.

    
    

11. Respondent's witness concedes the possibility that the wax pattern breaking influenced in a negative fashion the judgment of the graders. However, as previously found, there were several other identified deficiencies on this procedure, and the low grades awarded rate to the procedure in its entirety--not solely to the fracture. There is no showing this procedure was unfairly or improperly graded.

    
    

12. Although the examiners are not told how to withdraw the pattern during the standardization briefing other than to do it carefully, all examiners are licensed dentists and should know how to remove a wax pattern.

    
    

    CONCLUSIONS OF LAW

    
    

13. The Division of Administrative Hearings has jurisdiction over the parties and the subject matter of the proceedings.

    
    

14. Chapter 466, Florida Statutes (1981), regulates the practice of dentistry in the State of Florida and includes within the requirements for licensing the passage of a manual skills examination by graduates of foreign dental schools before they are permitted to take the National Board's examination in Florida.

    
    

15. Section 455.217(2), Florida Statutes (1981), sets up a procedure for review of examinations by unsuccessful examinees. The procedures followed by the Board in this case were in conformity with the procedures set out in the statute.

    
    

16. Petitioner has questioned two procedures he feels were unfairly graded. These procedures were thoroughly discussed in the Findings of Fact which resulted in a determination that the procedures were properly graded under the circumstances.

    
    

17. There was also a finding that Petitioner had failed to present any concrete evidence of discrimination by the Board or the State of Florida against graduates of foreign dental schools as alleged by Petitioner.

    
    

18. Petitioner has failed to carry the burden necessary to show that an error was made in the determination of his grade, that the examination was improperly administered, that his procedures were graded differently than were those of other persons, or that graduates of foreign dental schools are improperly or unfairly singled out for discriminatory treatment by the Board.

RECOMMENDATION

Based on the foregoing, it is, therefore, RECOMMENDED:

That a final order be entered by the Board of Dentistry finding that Petitioner has failed to achieve a passing score on the December, 1982, Dental

Mannequin Examination and upholding the grade awarded to him on that examination.

RECOMMENDED this 8th day of November, 1983, in Tallahassee, Florida.

ARNOLD H. POLLOCK, Hearing Officer Division of Administrative Hearings The Oakland Building

2009 Apalachee Parkway

Tallahassee, Florida 32301

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 8th day of November, 1983.

ENDNOTE

1/ Graduates of foreign dental colleges or dental schools not approved by the [Florida] Board must successfully pass a mannequin examination prior to being allowed to take the National Board of Dental Examiners' dental examination.

COPIES FURNISHED:

Habib H. Ghahremannezhad, D.M.D. 2127 Audubon Street, #91

Thibodaux, Louisiana 70301

Frank Vickory, Esquire Department of Professional

Regulation

130 North Monroe Street Tallahassee, Florida 32301

Mr. Fred Roche Secretary

Department of Professional Regulation

130 North Monroe Street Tallahassee, Florida 32301

Mr. Fred Varn Executive Director Board of Dentistry

Department of Professional Regulation

130 North Monroe Street Tallahassee, Florida 32301

Docket for Case No: 83-001550

Orders for Case No: 83-001550