Jun 13 2008 15:23 JUN-13-2888 15:58 AHA P.@2 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO.: 2006-43118 EDWARD S. POLSKY, D.M.D., RESPONDENT. _A NI MP COMES NOW Petitioner, Department of Health, by and through its | undersigned counsel, and files this Administrative Complaint before the Board of Dentistry against Respondent, Edward S. Polsky, D.M.D., 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 Statites; arid 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 4005. Jun 13 2008 15:23 JUN-13-2888 15:58 AHCA P.@3 3. Respondent's address of record is 3181 N.W, 61* Street, Boca - Raton, FL 33496. | 4. The Respondent provided dental treatment to Patient W.N. from on or about March 23, 2006, to on or about April 10, 2006. 5. On or about March 23, 2006, Patient WN, then a ninety-one (91) year-old male, presented to Respondent regarding what the patient deemed was a chip in a tooth in the patient's upper denture. The Respondent found a fracture in the acrylic in the patient's upper denture. Patient W.N. also complained of food collecting on the lower right side of | his mouth. The Respondent found that teeth #28 and #30 had been bonded together by a previous treater and the joint between the teeth was breaking, allowing the teeth to separate. The Respondent also found a chronic periapical infection on tooth #30. The Respondent recommended | repair of the upper denture and extraction of teeth #28 and #30. 6. ‘On or about March 23, 2006, the Respondent repaired Patient “ WANS upper denture and referred the patient to another treater-to perform the extractions. 7, On or about March 27, 2006, the Respondent took impressions for a lower partial denture to be placed in Patient W.N.’s mouth after the -De 3:\PSU\Medical\Dentistry\Schiefelbein\Dental Cases\Polsky\polsky.ac.m.doc Jun 13 2008 15:24 JUN-13-2888 15:58 AHCA P.a4 extractions of teeth #28 and #30 were performed. On or about March 30, 2006, the other treater extracted Patient W.N.'s teeth #28 and #30. 8. On or about April 3, 2006, Patient W.N. returned to the Respondent with swollen gum tissue, and the Respondent placed a lower partial denture in Patient W.N.’s mouth. | 9. On or about April 4, 2006, Patient W.N. returned to the Respondent with discomfort, and the Respondent thereupon adjusted the lower partial denture. | | 10. On or about April.10, 2006, Patient W.N. again returned to the Respondent with discomfort, and the Respondent again adjusted the lower -partial denture. 11. Thereafter, Patient W.N., who had been vacationing in Florida during the period’ of treatment by the Respondent, returned to his permanent residence in Massachusetts. 12. On or about December 19, 2006, Patient W.N. filed a complaint with the Department alleging ‘that the iower partial denture-was-not-fitted -- properly by the Respondent. “3 — 3:\PSU\Medical\Dentistry\Schiefelbein\Dental Cases\Polsky\polsky.ac.m.doc Jun 13 2008 15:24 JUN-13-2888 15:59 AHCA P.@S 13. The Respondent's records for Patient W.N. do not include a written record of the treatment plan proposed and/or rendered for the patient's treatment. | 14. The Respondent's records for Patient W.N. do not reflect whether the Respondent advised the patient of the risks and benefits associated with the extractions of teeth # 28 and #30 and/or whether treatment alternatives were discussed with the patient. 15. The Respondent's records for Patient W.N. do not include an adequate number of dental radiographs, particularly of the patient's maxilla. 16. The Respondent's records for Patient W.N. do’ not ‘comprehensively record ‘or chart the patient's existing dentition, the. patient’s existing restorations, the patient's tooth decay, and/or the restorations proposed by the Respondent. ) 17. The Respondent's records for Patient W.N. do not record the patient's periddsntal condition; including periodontal pocket depth probing measurements. 18. The Respondent's records for Patient W.N. are illegible. -G— J:\PSU\Medical\Dentistry\Schiefelbein\Dental Cases\Polsky\polsky.ac.m.doc Jun 13 2008 15:24 JUN-13-2888 15:59 AHCA P.@6 19. The Respondent's records for Patient W.N. do not reflect the nature or extent of the crack in the maxillary complete denture and how it was repaired. 20. The Respondent's records for Patient W.N. do not reflect the reason(s) for requesting the extraction of teeth #28 and #30. 21. The Respondent’s records for Patient W.N. do not reflect the nature of the denture adjustments that Respondent performed on or about April 4, 2006, and/or April 10, 2006. . 22. Section 466.028(1)}(m), Florida Statutes (2005), provides that 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, constitutes grounds for disciplinary action by the Board of Dentistry. 23, Rule 64B5-17.002(1), Florida Administrative Code, provides that for the purpose of implementing the provisions of Section 466,028(1)(m), ~~ ——"Figrida Statutes, a dentist shall maintain -written records-on each patient... - which written records shall contain, at a minimum, the following - information about the patient: (a) Appropriate medical history; (b) Results of clinical examination and tests conducted, including the identification, or -5- J:\PSU\Medical\Dentistry\Schiefelbein\Dental Cases\Polsky\polsky.ac.m.doc JUN-13-2688 15:59 AHCA Fan 18 2008 128 P.a? lack thereof, of any oral pathology or diseases; (c) Any radiographs used for the diagnosis or treatment of the patient; (d) Treatment plan proposed by the dentist; and (e) Treatment rendered to the patient. 24. | Respondent failed to keep written dental records and medical history records justifying the course of treatment of Patient W.N,, in one or more of the following ways: | (a) by failing to adequately record or chart Patient W.N.'s existing dentition, existing restorations, tooth decay, and/or the restorations proposed by the Respondent; (b) by illegibly and/or otherwise incompletely recording the dental treatment rendered by the Respondent to Patient W.N.; (c). by not including a written record of the treatment plan proposed and/or rendered for Patient W.N.’s treatment; (d) by not reflecting whether the Respondent advised Patient W.N. of the risks and benefits associated with the extractions of teeth #28 and “#30 and/or whether ‘treatitient alternatives~were~discussed: with the patient; . (e) by not including an adequate number of dental radiographs, particularly of Patient W.N.’s maxilla; -6— J:\PSU\Medical\Dentistry\Schiefelbein\Dental Cases\Polsky\polsky.ac.m.doc Jun 13 2008 15:25 JUN-13-2888 15:59 AHCA P.@8 (f) by not recording Patient W.N.'s periodontal condition, including periodontal pocket depth probing measurements; (g) by not reflecting the nature or extent of the crack in Patient W.N.'s maxillary complete denture and how it was repaired; (h) by not reflecting the reason(s) for requesting the extraction of Patient W.N.'s teeth #28 and #30; and/or (i) by not reflecting the nature of the denture adjustments that Respondent performed on Patient W.N. on or about April 4, 2006, and/or April 10, 2006. 25. Based on the foregoing, the Respondent has violated Section '466.028(1)(m),’ Florida Statutes (2005), by failing to keep written dental records and medical history records justifying the course of treatment of Patient W.N., including but not limited to patient histories, examination results, test results, and X-rays, if taken. WHEREFORE, Petitioner respectfully requests that the Board of Dentistry enter an order imposing one or more of the fellowing- penalties: revocation or suspension of the Respondent's license, restriction of practice, imposition of an administrative fine and costs, issuance of a reprimand, placement of the Respondent on probation, corrective action, -7—-— J:\PSU\Medical\Dentistry\Schiefelbein\Dental Cases\Polsky\polsky.ac.m.doc Jun 13 2008 15:25 JUN-13-2888 16:88 AHCA refund -of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. _ SIGNED this [S day of February, 2008. Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General Assistant General Counsel bocwty [Soy _ DOH Prosecution Services Unit FILED ' 4052 Bald Cypress Way, Bin C-65 : ons Tallahassee, FL 32399-3265 CLERK: Fe Catan Florida Bar No. 265047 ~ paTE_poig-0% Ph.: (850)245-4640, Fax: (850)245-4683 WLS PCP: 2/1576 £ PCP Members: CM WW, Wk. BOHN ¥. Edwards. Pélsky, D.M.D., “Case No, 2006-43118 -B- JI:\PSU\Medical\Dentistry\Schiefelbein\Dental Cases\Polsky\polsky.ac.m.doc Jun 13 2008 15:25 JUN-13-2888 16:88 AHCA P.1a 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 v. Edward S. Polsky, DMD. Case No. 2006-43118 -9- J:\PSU\Medical\ Dentistry\Schiefelbein\Dental Cases\Polsky\polsky.ac.m.doc

Docket for Case No: 08-002812PL