STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FOR HEALTH CARE )

ADMINISTRATION, BOARD OF )

DENTISTRY, )

)

Petitioner, )

)

vs. ) Case No. 95-6165

)

SANDRA L. JAUDON, D. M. D., )

)

Respondent. )

)

RECOMMENDED ORDER

A hearing was held in this case in Tampa, Florida on April 1, 1997, before Arnold H. Pollock, an Administrative Law Judge with the Division of Administrative Hearings.

APPEARANCES

For Petitioner: Natalie Duguid, Esquire

Agency for Health Care Administration Post Office Box 14229

Tallahassee, Florida 32317-4229

For Respondent: Sandra L. Jaudon, D. M. D., pro se

Post Office Box 2023 Brandon, Florida 33551

STATEMENT OF THE ISSUE

The issue for consideration in this case is whether Respondent's license as a dentist in Florida should be disciplined because of the matters alleged in the Administrative Complaint filed herein.

PRELIMINARY STATEMENT

By a three Count Administrative Complaint as amended dated October 6, 1993, the Petitioner charged Respondent with incompetence, negligence or failing to meet minimum standards in the practice of dentistry; by entering a plea of nolo contendere to, regardless of adjudication, a crime relating to the practice of dentistry; and by failing to make available to a patient

copies of documents relating thereto which were in her possession; all in violation of Section 466.028(1), Florida Statutes. The latter alleged offense, relating to the documents, was dismissed by the Petitioner at hearing. Respondent requested formal hearing, and this hearing ensued.

At the hearing, Petitioner presented the testimony of Dr.

Thomas Floyd, a pediatric dentist; Dr. W. Edward Gonzalez, a pediatric dentist; Andrea Chilton, a senior investigator in the Agency's Medicaid fraud unit; T. E., a former patient of the Respondent and, by deposition, Dr. Charles T. Kekich, a dentist. Petitioner also introduced Petitioner's Exhibits 1 and 3 through 7.

Dr. Jaudon testified in her own behalf and introduced the testimony of Dr. Wayman D. Price and Dr. Michael O. Abdoney, both dentists, and also introduced Respondent's Exhibits A through N.

A transcript of the proceedings was provided and subsequent to the receipt thereof, both parties submitted Proposed Findings of Fact which were carefully considered in the preparation of this Recommended Order.

FINDINGS OF FACT

1. At all times pertinent to the issues herein, the Board of Dentistry was the state agency in Florida responsible for the licensing of dentists and the regulation of the dental profession in this state. Respondent, Dr. Sandra L. Jaudon, was licensed as a dentist in Florida having been issued license number DN 0007871.

   
   

   AS TO COUNT ONE:

   
   

2. In January 1985, Dr. Jaudon, practicing in Brandon, Florida, examined 15 year old T. E., then a resident of a foster home, under a Medicaid program in effect at that time. Though Respondent denies she was told of any pain by either T. E. or the foster mother, T. E. claims she was experiencing pain in her two front teeth and her foster mother had brought her in. Weighing the evidence and its relative probabilities, it is found that most likely T. E. was experiencing pain at this time and communicated this fact to the Respondent.

   
   

3. Dr. Jaudon had the foster parent fill out a complete medical history form and sign a consent form, and she also mailed a questionnaire to the child's physician. Respondent performed a complete examination, including x-rays on that first visit and did a cleaning and fluoride treatment. She also found T. E. had a few cavities, and, from the x-rays, concluded that she needed

   root canal work on two teeth. One of the teeth in issue was tooth number 8. Respondent informed the foster parent of this fact and, as a precaution, prescribed an antibiotic for tooth number 8, based on the x-ray. On the basis of the uncontroverted evidence of record, there is no evidence to indicate Dr. Jaudon's diagnostic was not proper, and it is found that it met the minimum standard for diagnosis.

   
   

4. On the second visit, on January 21, 1985, Dr. Jaudon filled several teeth and noted swelling over tooth number 8. Because of this, she postponed the root canal treatment until the swelling went down because of the possibility of spreading infection, but prescribed further antibiotics for the existing infection.

   
   

5. When the patient returned on February 1, 1985, Dr. Jaudon opened tooth number 8 and drained the infection, after which she sealed the tooth with a temporary closure. She also repeated the dose of antibiotics. Respondent contends that the prevailing standard at the time dictated that a tooth undergoing root canal therapy should be sealed between appointments. Both Petitioner's dentist witnesses concurred with this suggestion, and it is so found.

   
   

6. When T. E. came into the office on February 8, 1985, Dr. Jaudon placed a filling on tooth number 8 to establish a stable reference for continuing root canal therapy. Dr. Jaudon claims that neither T. E. nor her foster mother indicated the girl had experienced any pain during the previous week. T. E. disagrees, claiming she was still in pain and told the Respondent so. No doubt she did.

   
   

7. No further work was done, however, until a visit on April 10, 1985, when Dr. Jaudon reopened the tooth and cleaned it out. She then resealed it with a temporary filling, and again, the records fail to reflect any complaint of pain. Finally, on May 31, 1985, Dr. Jaudon reopened the tooth, re-treated it, inserted a cotton pellet, and sealed it with a temporary cover.

   
   

8. On August 5, 1985, T. E. saw Respondent again. At that visit, Respondent did an examination, took x-rays, and cleaned her teeth. Nothing out of the ordinary was noted, and notwithstanding T. El's claim of constant pain, the chart entries of the dental technician who performed the cleaning fail to reflect that T. E. complained of any pain since her last treatment on May 31, 1985. When Dr. Jaudon checked the condition of tooth number 8, she noted signs of new decay.

   
   

9. T. E. recalls that while Respondent was doing the root canal procedure, someone came into the treatment room and said

   that Medicaid would not pay any more. T. E. recalls that after that comment, Respondent ceased work on her. Dr. Jaudon claims she did not work on this patient further because she was not brought to the office. It is so found. Nonetheless, at that time of the last visit, T. E. had a swollen lip and was still experiencing pain.

   
   

10. T. El's foster mother later telephoned Respondent who indicated those symptoms were normal. However, when the symptoms persisted for several days, the foster mother called the Department of Health and Rehabilitative Services, under whose aegis, she was serving as a foster parent, but there is no indication what happened. On August 14, 1985, T. E. was seen at home by Dr. Charles Kekich, a dentist who was working with the Medicaid fraud investigative team which was looking into the billing records of Dr. Jaudon, among others. At the time of this examination, T. E. was still in pain and experiencing difficulties with her teeth. Dr. Kekich examined T. E. on two or three separate occasions, but after this first examination, which was done in T. El's home, he referred her to the Health Department and she was then seen by Dr. W. Edward Gonzalez, a pediatric dentist in practice in Brandon who also specialized in Medicaid patients.

    
    

11. Dr. Gonzalez, who has in the past served as chairman of the Florida Board of Dentistry, saw T. E. in his office on September 24, 1985. At that time, she was still complaining about severe pain in and around tooth number 8. The doctor x- rayed that tooth and opened it. When he did so, he found a plug of intermediate restorative material extending half way down the root canal. At the time of the examination, the tooth was mobile and was painful as the result of a build up of pressure and fluid, an indication of infection. The gum tissue in the area of the tooth was red and inflamed. He did not request T. E.ts xrays from Respondent, as is customary to avoid a duplication of radiography.

    
    

12. Dr. Gonzalez removed the intermediate restorative material from the root. When the material was removed, Dr. Gonzalez determined that the tooth canal still contained necrotic pulp tissue which should not have been there. This was not proper work.

    
    

13. The accepted procedure for performing a root canal consists of cleaning and sterilizing the entire tooth canal, removing all debris and tissue from the inner portion of the tooth, medicating the tooth and cementing a plastic filling into the canal. The accepted standard of care in root canal therapy relied upon by the Board of Dentistry calls for the filling material not to extend beyond the apex of the tooth. During his

    examination of T. El's tooth number 8, he found that the intermediate restorative material extended 3 or 4 millimeters beyond the apex of the tooth. This was inappropriate.

    
    

14. After he had thoroughly cleansed the inner portion of the canal and rinsed it out, Dr. Gonzalez placed a pellet of forma creosol into the tooth and sealed it, sterilizing the inner portion of the canal. This relieved the patient of pain and constituted a permanent fix of the problem. The course of treatment performed by Dr. Gonzalez lasted over a period of approximately 13 months, ending in late October 1986.

    
    

15. Dr. Gonzalez opined that Respondent's treatment of this patient was below standard for several reasons. Among these was her failure to complete the procedure, and her application of a substance in the tooth which extended well beyond the apex.

    
    

16. T. El's records relating to tooth number 8 were also reviewed by Dr. Thomas Floyd, a Florida licensed pediatric dentist since 1978 and expert in the field of pediatric dentistry. He was also formerly the Florida Dental Association's liaison to the state Medicaid program for several years.

    
    

17. According to Dr. Floyd, a root canal is commenced by cleaning the canal with finger files or root canal files to remove all tissue within the canal. Dr. Jaudon's records relating to her root canal procedure on tooth number 8 on T. E. did not reflect the root canal was filed out or that any filling materials were placed in it. If the root chamber is not properly cleaned, and material is left inside, it can become necrotic and lead to infection. This is what happened in this case.

    
    

18. In Dr. Floyd's opinion, the temporary filling done by Dr. Jaudon in this case was inadequate and done in a grossly negligent manner. He found the filling occluded two-thirds of the root canal space. The infection which resulted caused T. E. to be maintained on antibiotics for an unnecessarily long period of time. Proper practice dictates the dentist will refer the patient to a specialist when it appears bacteria cannot be controlled over an extended period of time. In this case, Respondent's dental records for the patient reflect she was given antibiotics on January 7, January 21, February 1 and May 31, 1985, but they do not indicate why the antibiotics were prescribed after the initial dose. The records also fail to reflect whether the patient experienced any swelling, inflammation or infection in the area involved.

    
    

19. Respondent's records for this patient do reflect, however, that she began to treat tooth number 8 on February 1, 1985, and the last entry in the records was made on May 31, 1985.

    There is no indication in her records why the root canal treatment was not completed. An entry dated April 10, 1985 states, "we are waiting for P.A.# to continue work." This may indicate that Respondent stopped work on this patient pending further payment authorization by Medicaid, as T. E. contends, though Respondent denies this. Based on the evidence outlined above, it is most likely that T. E. and her foster parent were not satisfied with the lack of pain relief the patient was getting from Dr. Jaudon's treatment. When, as a part of the Medicaid audit being performed by Dr. Kekich, it was suggested T.

    E. be seen by Dr. Gonzalez, this was done, and she did not return to Respondent for any further treatment.

    
    

20. The records further show that on February 8, 1985, Respondent placed a permanent restoration on the mesial, buccal, lingual and incisal surfaces of tooth number 8. Placing a permanent filling in the area of a root canal which still contains necrotic or infectious debris is inappropriate practice as infection is likely to result. Ordinarily, permanent restorations are not placed on a tooth undergoing root canal treatment until the root canal has been completed. Records indicate that after placing the permanent restoration on tooth number 8, Respondent re-opened the tooth twice by drilling through the permanent restoration placed there in February 1985.

    
    

21. Based on the above matters, both Dr. Gonzalez and Dr. Floyd concluded that Dr. Jaudon's treatment on tooth number 8 in

    T. El's mouth during the period between January and May 1985 failed to meet the minimum standard of performance in diagnosis and treatment. Notwithstanding Respondent's disagreement, it is so found.

    AS TO COUNT II

    
    

22. Respondent does not dispute she pleaded nolo contendere in Circuit Court to 25 counts of Medicaid fraud. As a result of her plea, on November 19, 1986 she was placed on probation for one year on Counts 5 - 10 and 25 - 28, and one year consecutive for Counts 30 - 31. Beyond the routine conditions of probation, she was ordered to pay $238.00 in court costs; $952.00 in restitution to the Department of Health and Rehabilitative Services and $5,000 in prosecution costs to the Auditor of the Medicaid Department. Early termination of probation after one year was authorized.

    
    

23. In matters relating to discipline of a dental license, a plea of nolo contendere, by statute, creates a rebuttable presumption of guilt to the underlying criminal charges. Respondent strenuously rejects any claim that she was guilty of any fraud involving Medicaid payments.

    
    

24. According to Andrea Chilton, a senior investigator with the Agency's Medicaid Fraud Unit, the case against Respondent was generated based on a review of her billings due to a high percentage of three-surface restorations. At the beginning of the inquiry, Ms. Chilton secured a computer print-out of Respondent's billings and payments and selected a sample of them, relating to thirteen individual patients, for audit.

    
    

25. The Agency retained Dr. Kekich, a public health dentist whose activities for the past several years, almost exclusively have consisted of dental patient evaluations to determine evidence of Medicaid fraud, to examine patient records and to compare those records to his independent examination of the patients' mouths. In conjunction with Miss. Chilton, Dr. Kekich examined all thirteen patients and their records and, having found discrepancies, then looked at an additional fifteen patients and their records, and also found discrepancies.

    
    

26. Dr. Kekich, along with Special Agent Marcia Connell, who had been trained by Dr. Kekich to record dental procedures and fillings accurately, examined the first thirteen patients on August 14, 1985. Using an artificial light and a tongue blade, Dr. Kekcih looked into the patient's mouth and then called out by tooth number whether there was a filling present and if there was, what surfaces had been treated. If a tooth was missing he would call that out, or if a tooth had no fillings he would call that out as well. This examination procedure revealed a number of fillings for which Medicaid had been billed but which could not be found in the mouths of several patients.

27. Medicaid reimbursed dentists on the basis of the surfaces restored. If there were more than one filling on a particular surface, only the designation of the surface was recorded, not the number of restorations per surface. This is the procedure followed during Dr. Kekich's examination of Respondent's patients.

    
    

28. After the first examination, the Medicaid office requested Dr. Kekich reexamine the patients and note each restoration. There were changes in the count. For example, during the first examination of T. E., Dr. Kekich noted that the occlusal surface of tooth number 14 had been restored. During the reexamination conducted on May 15, 1986, approximately nine months later, T. El's mouth showed two restorations on the occlusal surface of tooth number 14.

    
    

29. Respondent's records regarding T. E. reflect that on February 18, 1985, Respondent billed for a three-surface restoration on tooth 14. The records also reflect that the same day, she billed for a three surface restoration of tooth number

    15 when the two examinations by Dr. Kekich revealed only one surface had been restored. By the same token, on March 1, 1985, she billed for a three surface restoration or both teeth numbers

    30 and 31, but the examinations reveal only one restoration on each tooth.

    
    

30. Ms. Chilton interviewed Respondent and asked her to explain those discrepancies and her procedure for treating Medicaid patients and her billing practices to EDS, the Medicaid billing agent. Dr. Jaudon was unable to clearly explain what had happened, claiming merely that she "didn't pay attention to their codes or their things I should have known ...," but the difference may be explained by the method used by Dr. Kekich to record procedures done.

    
    

31. Based on this interview and the examinations of patients and records, Ms. Chilton found discrepancies on twenty- seven of twenty-eight cases totaling $952.00 for services billed but allegedly not rendered

    
    

32. Notwithstanding her plea, Respondent has consistently maintained her innocence of any Medicaid fraud. Over the years of her practice, she claims she has treated literally thousands of Medicaid patients and has never been the subject of any complaint regarding their treatment. In the instant case, Respondent was selected for audit because of the relatively high number of three surface restorations for which she billed. She claims, however, that in all her billings she had followed the acceptable standards of the American Dental Association for tooth notation and billing codes.

33. In addition, she asserts she has always utilized Medicaid prior authorization forms when requesting permission for treatment on patients. The instructions on those forms calls for the use of the ADA system, and where appropriate, she would also include x-rays to facilitate the decision.

    
    

34. Dr. Jaudon questions the propriety of the examinations done by Dr. Kekich and his qualifications to evaluate her performance. She notes that he admitted to using only a light and a tongue blade to perform the examination. It should be noted, however, that he was merely looking at surface restorations and not doing a clinical examination.

    
    

35. As to Kekich's qualifications, he is a licensed dentist, and though he has not been in dental practice for many years, having served as an agency consultant and examiner, possesses adequate technical credentials to perform the minimal surface examinations he did here. By the same token, the fact that he has been an agency employee for many years does not necessarily mean, as claimed by Respondent, that he was not familiar with the methods for charting certain types of fillings as prescribed by the ADA. However, it was shown that on two different patients, surface restorations that Dr. Kekich said were missing were, in fact, present.

    
    

36. n Of all Respondent's procedure billings, including examinations, x-rays, white fillings, crowns, and extractions, only silver amalgam fillings were questioned. Respondent asserted that of all the dental procedures performed on patients, the silver filling is the type that generates differences in opinion as to surfaces. Different dentists can look at a silver filling and interpret it as one, or more than one, surface. When Dr. Kekich, at the request of the agency, reexamined some of the Respondent's patients he had previously examined, the results differed as to the identical teeth, even though no work on those teeth had been done in the interim. It was determined that on his first examinations, Dr. Kekich had made no distinction between O and OL fillings as is suggested by the ADA. These two fillings are different.

    
    

37. Respondent pointed out that O+OL is the proper way to notate this filling, and this was the way she had done it in her Medicaid authorization requests and billings without objection by the agency. Though Petitioner indicated at hearing that a manual alleged to be in existence in 1985 prohibited reimbursement for O+OL fillings, the manual was not presented and Dr. Kekich, when questioned at deposition, could not recall in what years a manual addressing this issue existed. Respondent contends, and it appears to be a reasonable assertion, that if Medicaid had had

    such a policy prohibiting that type of filling at the time, her requests for prior authorization would not have been approved.

    
    

38. A third examination of Respondent's patients in issue was conducted in May 1986 by a different dentist who was not called to testify at the hearing. The records of these examinations were not, in all cases, consistent with records of the prior two. Respondent claims, and Dr. Kekich agrees, that subjective interpretation and opinion can account for what a particular dentist calls a two or three surface filling, and that different examiners could identify a class 2 filling as either a two surface or a three surface filling.

    
    

39. Respondent does not deny that she pleaded nolo contendere to the misdemeanor charges. The grand theft charges were dismissed. She pleaded as she did for several reasons. She had been approached by several parents of the patients involved who asked if there was some way in which the examinations could be brought to an end because of the stress being occasioned to the children as a result of the repeated examinations. She also had substantial concerns about the effect the investigation was having on her family. There were financial concerns as well.

    She had expended considerable sums in attorney fees and costs up to this point and had been advised by her attorney that the cost of going to trial to contest the charges would be an additional

    $30,000. Her attorney advised her to plead nolo contendere because, he asserted, such a plea was not an admission of guilt.

    
    

40. Respondent has been licensed as a dentist in Florida since 1978 and has no prior disciplinary record. Both dentists, from whose offices she practiced, Drs. Wayman D. Price and Michael 0. Abdoney, would send her patients and, from time to time, see her patients. Neither has received or heard of any complaints from her patients or their own patients regarding her treatment.

    
    

41. She continued to treat Medicaid patients throughout the investigation to no cost to insure they received proper care and to ward off any issue of patient abandonment. Any money received from Medicaid during the investigation was placed by Respondent into escrow. She has cooperated with the investigation and in no way unreasonably caused the delay in coming to hearing. Because of financial considerations, she has, from time to time, had to proceed without counsel, and was not represented at this hearing, her counsel having withdrawn shortly before the hearing.

    
    

42. Though in 1987 she withdrew from practice out of deference to her patients and because of the large amount of time needed to devote to the defense of the matters alleged here, Respondent has continued to take all and more than is required of

    continuing education courses in an effort to keep current with developments in her field. She has met all the conditions of her probation and it was successfully terminated.

    
    

    CONCLUSIONS OF LAW

    
    

43. The Division of Administrative Hearings has jurisdiction over the parties and the subject matter in this case. Section 120.57(1), Florida Statutes.

    
    

44. With the withdrawal of Count III of the Administrative Complaint, relating to the failure to release records, the only charges remaining against the Respondent are those relating to her failure to meet minimum standards of practice, in violation of Section 466.028(1)(y), Florida Statutes, and to her plea of nolo contendere to a crime related to the practice of dentistry, in violation of Section 466.028(1)(c), Florida Statutes.

    
    

45. Pursuant to Section 466.028(2), the Board of Dentistry has the authority to discipline a license to practice dentistry in Florida for violations of the various provisions of Section 466.028(1). These include incompetence or negligence by failing to meet minimum standards in diagnosis and treatment, and being found guilty of a crime which relates to the practice of dentistry. Petitioner has the burden to establish Respondent's guilt of the violations alleged by clear and convincing evidence. Ferris v. Turlington, 510 So.2d 292 (Flat 1987).

    
    

46. Count I one the Complaint, relating to T. E., alleges that Respondent was incompetent and negligent in her treatment of T.E., including but not limited to root canal treatment, and thereby failed to meet minimum peer standards in the community. The evidence presented by the Board with regard to this patient was directed to the root canal treatment rendered. There was no evidence, other than incidental, regarding any other treatment rendered and nothing was presented to indicate the Respondent did not meet standards in her diagnosis of T.E.'s problem.

    
    

47. With regard to the treatment rendered, however, there is a different story. Once Dr. Kekich began his investigation into the allegations of Medicaid fraud, T. E. was referred to the County Health Department clinic and from there to Dr. Gonzalez. She was not brought back to Dr. Jaudon to finish the treatment started, and Respondent is not faulted for not having completed the process. By the same token, the Medicaid fraud charge, even if proven does not constitute treatment below standard, as urged by Dr. Floyd. However, the evidence clearly establishes the work she did on tooth number 8 was below minimum standards. The evidence clearly shows she placed a permanent cap on tooth number

    8 even though the canal still contained necrotic material. The

    evidence also shows that the plug she placed in the tooth extended by several millimeters beyond the apex of the tooth.

    
    

48. The issue with regard the Medicaid fraud prosecution is not so clear, however. Section 466.028(1)(c), Florida Statutes, authorizes the Board to discipline a dentist who enters a plea of nolo contendere to a crime which relates to the practice of dentistry. In the instant case, Respondent entered such a plea to twenty-seven counts of misdemeanor Medicaid fraud, and the statute also provides that a plea of nolo contendere creates a rebuttable presumption of guilt to the underlying criminal charges.

    
    

49. The operative word here is rebuttable. The term, nolo contendere means "no contest", and generally one who enters such a plea does so as a part of a plea arrangement which benefits both the prosecution and the defendant. It is equally true, however, that often such a plea is entered by one who is not guilty of the underlying criminal charge because of a myriad of reasons best known to that individual. Such, claims Dr. Jaudon, is the case here.

    
    

50. By the time she entered her plea, Dr. Jaudon's patients had been subjected to at least three separate examinations by dentists unknown to them as a part of the investigation into the Respondent. These patients' parents came to her and asked her to bring the process to an end. As a caring individual, she could see the need to do so but could see no other way to do that than to plead nolo contendere to the charges. Further, the process was taking its toll on her family, both emotionally and financially, and she was advised that to continue the fight would involve the expenditure of additional sums she did not have. Therefore, based on the advice of her counsel, she entered the plea of nolo contendere even though she believed she was not guilty of the fraud alleged.

    
    

51. The underlying facts of the fraud case rest upon the examinations of Dr. Kekich and the other dentist who conducted the third set of examinations which, when compared with the billings submitted by Respondent, indicated she had billed for approximately one hundred nineteen surfaces at $8.00 per surface, which did not appear in the patients' mouths. There was no indication her billings for any other procedure were incorrect. Considering that the three investigatory examinations each produced different results regarding the same teeth, the evidence is neither clear nor convincing that she intentionally misbilled.

    
    

52. Further, the evidence regarding how Medicaid reimbursed, and how Dr. Kekich identified questioned procedures, pertaining to the way of recording numbers regardless of surfaces

    treated, is confusing and makes it impossible to conclude that Respondent intentionally and improperly billed for the work done. This is especially true when the uncontroverted evidence of record suggests that she did not do her own billing and did not carefully oversee the billing submissions of her clerk. This clearly constitutes sloppy office management, but that is not tantamount to actionable misconduct. Consequently, it is concluded that Respondent has successfully rebutted the presumption of guilt of Medicaid fraud.

    
    

53. Rule 59Q-13.005(3)(d), Florida Administrative Code is the rule which allows the Board to impose any of the penalties specified in Section 466.028(2), Florida Statutes for a proven violation of the statute as described, supra. dependent upon the gravity of the underlying misconduct. In this case the Board seeks to suspend Respondent's license for six months, place her on unlimited probation, reprimand her license and fine her administrative costs of $6,000. This suggested penalty presupposes her being found guilty of all alleged offenses.

    
    

54. However, after a careful consideration of all the evidence, it has been concluded that Respondent is not guilty of Medicaid fraud and guilty only of one instance of treatment below minimum standards. Consequently, so severe a penalty as that proposed by the Board is not appropriate. In light of the substantial costs already paid as a result of the plea entered in circuit court, an additional significant fine would seem too severe, and her performance below standard in this isolated instance is not so severe as to require suspension.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of Law, it is recommended that the Board of Dentistry enter a final order dismissing so much of Count I of the Administrative Complaint as alleges Respondent is guilty of diagnosis below standard, but finding her guilty of treatment below standard in the root canal treatment of T.E. It is further recommended that Count II of the Administrative Complaint be dismissed. It is further recommended that Respondent's license be reprimanded and placed on probation for a period of six months.

DONE and ENTERED this 19th day of May, 1997, in Tallahassee, Florida.

ARNOLD H. POLLOCK

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building 1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

(904) 488-9675 SUNCOM 278-9675

Fax Filing (904) 921-6847

Filed with the Clerk of the Division of Administrative Hearings this 19th day of May, 1997.

COPIES FURNISHED:

Natalie Duguid Esquire Agency for Health Care

Administration

Post Office Box 14229 Tallahassee, Florida 32317-4229

Sandra L. Jaudon, D. M. D., pro se Post Office Box 2023

Brandon, Florida 33599-2023

William Buckhalt, Executive Director Agency for Health Care

Administration Board of Dentistry Northwood Centre

1940 North Monroe Street Tallahassee, Florida 32399-0792

Jerome W. Hoffman, General Counsel Agency for Health Care

Administration 2727 Mahan Drive

Tallahassee, Florida 32308-5403

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within 15 days from the date of this recommended order. Any exceptions to this recommended order should be filed with the agency that will issue the final order in this case.

Docket for Case No: 95-006165

Orders for Case No: 95-006165