STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, CASE NUMBER: 2000-00628 vs, DOUGLAS PETERSON, D.D.S. RESPONDENT. / ADMINISTRATIVE COMPLAINT COMES NOW, the Petitioner, Department of Health, hereinafter referred to as "Petitioner", and files this Administrative Complaint before the Board of Dentistry against, DOUGLAS PETERSON, D.D.S., referred to as "Respondent", and alleges: 1. Effective July 1, 1997, Petitioner is the state agency charged with regulating the practice of Dentistry pursuant to Section 20.43, Florida Statutes, Chapter 456, Florida Statutes, (formerly Chapter 455, Part II; see Chapter 2000-160, Laws of Florida), and Chapter 466, Florida Statutes. Pursuant to Section 20.43(3)(g), Florida Statutes, the Department has contracted with the Agency for Health Care Administration to provide consumer complaint, investigative, and prosecutorial services required by the Division of Medical Quality Assurance, councils, or boards, as appropnate. 2. Respondent is, and has been at all times material hereto, a licensed dentist in the State of Florida, having been issued license number DN 9930. Respondent's last known address is 2411 10" Avenue, North, Lake Worth, Florida 33641. 3. On or about May 17, 1993, through on or about August 6, 1996, Patient $.G. was a patient of record of the Respondent. 4. Patient S.G. had extensive treatment done by the Respondent to his mouth including: Root canals on teeth numbers four, eleven, and thirteen; crowns on teeth numbers twelve, thirteen, fourteen, fifteen, two, three, four, and five; a lower partial denture made; and bleaching. One prophylaxis was done to Patient S.G,'s mouth on or about May, 1993. 5. Respondent failed to note in the Patient's chart that Patient S.G.'s gingival was grossly inflamed with significant periodontal disease producing severe pain. 6. The Respondent's dental records for Patient S.G. from on or about May 17, 1993, through August 6, 1996, did not include the following: a.) Records of a periodontal exam; b.) Records of a comprehensive exam; c.) Periodontal diagnosis or classification; d.) Records of periodontal probings; e.) Records of an outlined sequence of treatment planning; and £.) No notations about periodontal progress or lack of progress. 7. Based on the foregoing, the Respondent's license to practice dentistry in the State of Florida is subject to discipline pursuant to Section 466.028 (1) (m), Florida Statutes, for failing to keep written dental records and medical history records justifying the course of treatment of the patient including, but not limited to, patient histories, examination results, test results, and X-rays, if taken. WHEREFORE, Petitioner respectfully requests the Board of Dentistry enter an order imposing one or more of the following penalties: revocation or suspension of the Respondent's license, restriction of the Respondent's practice, imposition of an administrative fine and costs, issuance of a reprimand, placement of the Respondent on probation, and/or any other relief that the Board deems appropriate. SIGNED this [é Pay of eel , 2001. Robert G. Brooks, M.D. Secretary, Department of Health BY: Nancy M. Snurkowski Chief Attorney Agency for Health Care Administration COUNSEL FOR AGENCY John L. Chaves Senior Attorney Agency for Health Care ; LED Administration ae ENT OF sEPARTM K is) DEPUTY CLER Practitioner Regulation ; ra ene 24 att P. O. Box 14229, mail stop 39 Tallahassee, Florida 32317- 4229 (850) 487-9670 pon IC/mI//clt PCP: Garcia and Robinson DATE: August 30, 2001

Docket for Case No: 02-001945PL