Mar 19 2009 16:30 MAR-19-2889 16:12 AHCA P.a@2 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, vs. CASE NUMBER: 2006-43077 EBRAHIM MAMSA, D.D.S., ‘RESPONDENT. _—_/ ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Dentistry against the Respondent, Ebrahim Mamsa, D.D.S., 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 Statutes; and 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 10792. 3. Respondent's last known address of record is: 10285 Cove Lake Drive, Orlando, Florida 32836. 8002 @¢n vw Mar 19 2009 16:31 MAR-19-2089 16:15 AHCA P.@3 4, The Respondent provided treatment to Patient J.L. from on or about January 30, 2006, to on or about January 9, 2007. 5, Patient J.L, presented to Respondent on or about January 30, 2006, with the request to diagnose a tooth that was in pain. Patient J.L. wanted to have her existing lower partial denture adjusted to account for the extraction of the tooth, if extraction was necessary. The Respondent's treatment records for the initial visit indicated that one radiograph was taken of tooth number 20 and that tooth number 20 was extracted. 6 Respondent's clinical notes for Patient J.L., dated January 30, 2006, state, " 1 PA #20, P. cons Ext #20 ....” The clinical notes are devoid of the anesthesia type or amount used. Respondent did not have Patient J.L. sign an Informed Consent form. Respondent did not notate that he addressed alternative treatment to extraction of tooth number 20 with Patient J.L and/or he failed to discuss alternatives to the extraction of tooth number 20 with Patient J.L. Respondent did not formulate or present a comprehensive treatment plan for Patient J.L. during the initial visit. 7. Onor about January 30, 2006, Respondent charted Patient J.L.’s teeth which indicated seven (7) upper teeth and ten (10) lower teeth present. However, Respondent, on this date, took only one periapical . . \ 2 . 3:\PSU\Medical\Dentisty\David Flynn\Admin Complaints\ac’s O2MAY08\mamsa(x)(m).coc Mar 19 2009 16:31 MAR-19-2089 16:15 AHCA P.a4 radiograph of tooth number 20 before proceeding to bill and collect from Patient J.L. ten thousand dollars for future needed treatment. Patient J.L. asserts that she was not sure of the treatment planned due to a communication barrier and a failure of Respondent to adequately present a detailed comprehensive treatment plan. 8. From on or about January 30, 2006, through on or about January 9, 2007, Respondent took a total of three (3) periapical radiographs of Patient J.L., which are not dated. The radiographs taken show a total of three (3) and one-half (1/2) different teeth out of a total of seventeen (17) teeth. 9. On or about January 30, 2006, Respondent checked “no” to Advanced Periodontitis and to Isolated Periodontal Disease without performing adequate periodontal examination(s) and/or periodontal pocket depth charting before developing a treatment plan for Patient J.L. --- 10, -On-orabout January. 30, 2006, Respondent, with one radiograph of Patient J.L.’s tooth number twenty (20) and with no_ periodontal examination=and/or ‘periodontal-charting,-developed~a-treatment-plan that totaled an even 10,000 dollars of needed treatment. Respondent collected J:\PSU\Medical\Dantistry\David Flynn\Admin Complaints\AC's O2MAYOa\mamea(x)(m).doc Mar 19 2009 16:31 MAR-19-2889 16:13 AHCA P.@S the 10,000 dollars through a line of credit established by a financial company offered by Respondent. 11. On or about January 30, 2006, Respondent failed to articulate and or notate a clear and concise treatment plan that was intelligible to Patient J.L., and/or to a trained professional in the field of dentistry. The treatment record dated January 30, 2006, states,“ 1 P.A. # 20, Pt. cons Ext 20. Brg 18 + 22 Brg 25+27. .... Pro Temp.” Further, quantitative notes regarding the treatment plan that Respondent billed 10,000 dollars for are confusing and misleading and do not coincide with the dental chart or the recorded notes dated January 30, 2006. 12, Respondent asserts, in a subsequent response to the department's investigation, on of about January 30, 2006, that he placed crowns on Patient J.L.‘s tooth numbers 25, 26, and 27. This treatment was not listed as being done in Respondent's treatment records nor was there any radiographs taken of this area before Respondent began treatment in this area to justify the course of treatment. 13. On or about February 7, 2006, Respondent's treatment notes reflect in part, “Pt wants to change treatment to /p.” The Respondent took an impression for a lower partial notwithstanding that Respondent noted a -4- 3:\PSU\Medical\Dentistry\David Flynn\Admin Complaints\AC’s O2MAYO8\mamsa(x)(m).dac Mar 19 2009 16:32 MAR-19-2089 16:14 AHCA P.@6 dry socket in the recently extracted site of tooth number 20. Respondent does not indicate the reason for a change in the treatment plan or the discussion he had with Patient J.L. regarding the change in the treatment plan. Respondent’s records do not indicate the sequence of his new treatment plan for Patient J.L. Further, Respondent's treatment records are devoid of later delivery, try-in, or any adjustments of a lower partial denture that he took an impression for on or about February 7, 2006. 14. On or about May 22, 2006, Patient J.L. presented back to Respondent. Respondent’s treatment notes ‘indicated that a periapical radiograph was taken of tooth number 18°. Further, treatment was performed on Patient J.L.’s tooth that Respondent labels as 18 and a temporary crown was placed. Respondent’s records do not reflect the diagnostic reason for the treatment/s or the test/s performed to confirm the treatment necessity. Further, the Respondent's treatment notes do not indicate that -treatment—alternatives..were—explained to Patient J.L. Radiographic evidence of Patient J.L.’s tooth 18 indicated the tooth had —~furcation bone defect and=mesiat-vertical hone toss —whichindicates that tooth number 18 may have been a poor candidate for crown treatment. ' Radiographic evidence indicates that Respondent's reference to Patient J.L.’s tooth number 18 may be tooth number 17. -5- J:\PSU\Medical\Dentistry\David Flynn\Admin Complaints\AC's 02MAY08\mamsa(x)(m).doc Mar 19 2009 16:32 MAR-19-2889 16:14 AHCA Pa? However, periodontal evaluation of tooth number 18, which was not recorded and/or performed by Respondent, is unavailable to justify the Respondent's course of treatment on Patient J.L.’s tooth number 18. 15. Respondent's treatment records dated May 22, 2006, do not indicate that the lower removable partial denture was ever delivered to Patient J.L. Respondent proceeded,” on or ~about~May 22," 2006, with restorative treatment on tooth number 18. Respondent began his fixed dentistry treatment of tooth number 18 after beginning his restorative treatrnent of fabricating a lower partial removable denture. In order to ensure a proper fit, function, and stability of the lower removable partial denture, Respondent should have first treated Patient J.L.’s tooth number 18. However, Respondent's records are devoid of treatment notes indicating the rationale for his treatment sequence of proceeding first with fabricating a jower removable partial denture and then proceeding to restore tooth 18 --with-a -crewn. _ we wee we a 16. On or about June 4, 2006, Patient J.L. presented back to “Respondent: --Respondent-seated a-crown on-tooth number-+8—Fhere- are not any treatment notes to indicate if the jower partial was delivered. -6- J:APSU\Madical\Dentistry\David Flynn\Admin Complaints\aC's O2MAYOB\mamea(x)(m).doc Mar 19 2009 16:32 MAR-19-2089 16:14 AHCA P.@8 17. On or about January 9, 2007, Patient J.L. presented back to Respondent. Patient J.L. was displeased with her treatment and flack of informed decision making. Respondent agreed to refund Patient J.L. for treatment performed. Patient J.L. asserts that she presented with an old © lower removable partial denture, and Respondent discarded the denture without her consent or knowledge. 18. The prevailing minimal standard of dental care when a dentist is presented with a patient, such as J.L. for the first time includes, but is not limited to; performing an adequate diagnosis through taking an adequate quantity and quality of diagnostic radiographs coupled with the appropriate clinical examinations, to include but not limited to, an adequate periodontal examination and periodontal pocket depth charting before developing an appropriate written comprehensive treatment plan and sequence. The comprehensive treatment plan should then be presented to the patient with alternative treatment options and an explanation of risks and benefits in order to obtain informed consent from the patient. The minimally prevailing standard of dental care also requires that any time there are changes in the treatment pian, the changes and rationale for the J:\PSU\Medical\Dentistry\David Flynn\Admin Complaints\ac's 02MAY08\mamsa(x)(M).doc Mar 19 2009 16:32 MAR-19-2089 16:14 AHCA P.@9 changes should be explained to and accepted by the patient, and adequately detailed in the treatment record. 19. Further, the minimum standards of performance in diagnosis and treatment when measured against generally prevailing peer performance require that a dentist performing extractions obtain appropriate informed consent that among other issues clearly describes: 1) the intended procedure and specific tooth or teeth which are to be extracted; 2) the proposed anesthetic; 3) the potential complications; 4) alternatives available; and 5) the need for follow up care. The informed consent should be clear, concise and legible, and include the patient's signature and date of that signature. 20. The minimum standard of record keeping requires a dentist to document the treatment performed and clinical necessity of the treatment so that a subsequent treating dentist could review that file and follow the sequence and clinical necessity of treatment in order to continue treatment of the-patient... —-—- = ee COUNT ONE: STANDA F CARE —==21, Petitioner réalleges and incorporates paragraphs-one-(4}-through twenty (20) as if fully set forth herein. -8- J:\PSU\Medical\Dentistry\David Flynn\Admin Complaints\AC's O2MAY08\mamsa(x)(m).doc MAR-19-2089 16:15 Mar 19 2009 16:33 AHCA 22. Section 466.028(1)(x), Florida Statutes (2005-2006), provides that being guilty of incompetence or negligence by failing to meet the minimum standards of performance in diagnosis and treatment when measured against generally prevailing peer performance, including, but not limited to, the undertaking of diagnosis and treatment for which the dentist is not qualified by training or experience or being guilty of dental malpractice constitutes grounds for disciplinary action by the Board of Dentistry. 23. Respondent was negligent and failed to meet the minimum standards of dental performance in one or more of the following ways: a) D) c) by failing, on or about January 30, 2006, through on or about January 9, 2007, to perform an independent adequate periodontal examination and/or pocket depth charting with diagnostic results noted, prior to developing a treatment plan or prior to initiating, or while performing treatment on Patient J.L.; by failing, on or about January 30, 2006, to perform an adequate radiographic survey or panoramic survey with diagnostic results noted prior to developing a treatment plan or prior to initiating, or while performing treatment on Patient J.L., and/or by failing through the entire course of treatment to take an adequate radiographic survey of Patient J.L.’s oral dentition; by failing, on or about January 30, 2006, to develop a comprehensive treatment plan for Patient J.L. and/or by failing to present Patient 2.L with a comprehensive treatment plan to obtain informed consent from Patient J.L.; -g- J:\PSU\Medical\Dentistry\David Flynn\Admin Complaints\AC's OZMAY08\mamsa(x)(m).doc MAR-19-2889 16:15 d) €) g) 1) h) Mar 19 2009 16:33 AHCA P.ii by failing, on or about January 30, 2006, to obtain written informed consent from Patient J,.L. before extracting tooth number 20; . by failing, on or about January 30, 2006, to discuss and/or notate the alternatives to extraction of tooth number 20 with Patient J.L.; by failing, on or about January 30, 2006, to notate and/or discuss the potential complications with Patient J.L. regarding the extraction of tooth number, 20 and the need for follow up care; by failing, on or about February 7, 2006, to develop a comprehensive treatment plan for Patient J.L. after deviating from the alleged original treatment plan; by taking, on or about February 7, 2006, an impression of Patient J.L’s denture for fabrication of Patient J.L.'s lower removable partial denture, while Patient J.L. had a dry socket in tooth space number 20, without documenting the clinical rationale of why Respondent did not wait until the dry-socket was healed; and/or by failing, from on about January 30, 2006, through the continued course of treatment to perform adequate clinical examination(s) and/or indicated radiographic examination(s). 24, Based on the foregoing, the Respondent has violated Section 466.028(1)(x ), Florida Statutes (2005-2006), by being guilty of incompetence or negligence by failing to meet the minimum standards of performance in diagnosis and treatment when measured against generally prevailing peer performance, including, but not limited to, the undertaking of diagnosis and -10- J:\PSU\Medical\Dentistey\David Flynn\Admin Complaints\Ac's O2MAYO8&\mamisa(x)(m).doc MAR-19-2889 16:15 AHCA P.12 Mar 19 2009 16:33 treatment for which.the dentist is not qualified by training or experience or being guilty of dental malpractice. COUNT TWO: DEFICIENT RECORDS 25. Petitioner realleges and incorporates paragraphs one (1) through twenty (20) as if fully set forth herein. 26. Section 466.028(1)(m), Florida Statutes (2005-2006), 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 discipline by the Board of Dentistry. 27. For purposes of implementing Section 466.028(1)(m), Rule 64B5-17.002, Florida Administrative Code, requires that a dentist shall maintain written records on each patient which shall contain, at a minimum, appropriate medical history; results of clinical examination and tests conducted including the identification, or lack thereof, of any oral pathology or diseases; any radiographs used for the diagnosis or treatment of the patient; treatment plan proposed by the dentist; and treatment rendered to the patient. -1d1- J:\PSU\Medical\Dentistry\David Flynn\Admin Complaints\AC's O2MAY08\mamsa(x}{m).doc MAR-19-2089 16:16 Mar 19 2009 16:34 SHCA P13 28. Respondent failed to keep written dental records and medical history records justifying the course of treatment in one or more of the following ways: a) b) c) d) é) g). by failing, on or about January 30, 2006, to document all the clinical examinations and results thereof performed on Patient J.L.; by failing, on or about January 30, 2006, to document the results of the periapical radiographic examination and/or other tooth examination to justify the extraction of tooth number 20; by failing, on or about January 30, 2006, to document the test(s)/examination(s) performed and the results thereof to justify the treatment of tooth numbers 25, 26, and 27; by failing, on or about January 30, 2006, to record the type and amount of anesthetic used during the extraction of Patient J.L’s tooth number 20; by failing, on or about January 30, 2006, to record the results of any periodontal probing of Patient J.L’s teeth if so performed; by failing, on or about January 30, 2006, to document a decipherable comprehensive treatment plan to justify the recommended course of treatment in the amount of 10, 000 dollars; by documenting, on or about January 30, 2006, that Patient j.L. did not have any periodontal disease without documenting the test(s)/examination(s) performed and the results thereof to justify the diagnosis and the course of treatment that did not include periodontal therapy; “i 3:\PSU\Medical\Dentistry\David Flynn\Admin Complaints\AC's O2MAYO8\mamsa(x)(m).doc MAR-19-2889 16:16 h) J) k) I) Mar 19 2009 16:34 AHCA F.1d by failing, on or about February 7, 2006, to document the Clinical rationale for altering Patient J.L.s course of treatment or the discussion with Patient J.L., to justify his course of treatment; by failing, on or about February 7, 2006, to begin fabrication of a removable prosthetic device, in the form of a lower removable partial denture, without documenting a treatment sequence or comprehensive treatment plan to justify the course of treatment to proceed with fixed restorative work, on or about May 22, 2006, prior to completion of the removable partial denture; by failing, on or about May 22, 2006, to document the test(s)/examination(s) performed and the results therefore of Patient J.L’s tooth number 18 to justify treating tooth 18 with a crown; by failing from on or about May 6, 2006, through January 9, 2007, to document the process of Patient J.L.’s removable lower partial denture to include, any try-in, adjustment(s), or delivery of the denture; and/or by failing, from on about January 30, 2006, through on or about January 9, 2007, to maintain treatment records for Patient J.L., which would allow a subsequent treating dentist to decipher what treatment had been performed and decipher the clinical necessity of the treatment. 29. Based on the foregoing, Respondent has violated Section 466.028(1)(m), Florida Statutes (2005-2006) by 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. -13- J:\PSU\Medical\Dentistry\David Flynn\Admin Complaints\AC's Q2MAY08\mamsa(x)(m).doc MAR-19-2889 16°16 AHCA Mer 19 2009 10 P.1S WHEREFORE, the Petitioner respectfully requests that 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 practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. SIGNED this 2ryva_ day of _{ Via , 2008, Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General id D. Flynn Assistant General Counsel DEPARTMENT OF HEALTH DOH Prosecution Services Unit oer Lo "E5 4052 Bald Cypress Way, Bin C-65 : Tallahassee, Florida 32399-3265 DATE___ &> “CE Florida Bar # 759511 850.245.4640 Ext. 8178 850.245.4683 FAX PCP: F 2/0 S PCP members: 9 yy 7, EF & 7 DOH vs. EBRAHIM MAMSA, D.D.S., Case No. 2006-43077 - 14 - J:\P5U\Medical\Pentistry\David Flynn\Admin Complaints\Ac's O2MAY08\mamsa(x}(m).doc Mar 19 2009 16:35 MAR-19-2089 16:17 AHCA P.16 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 vs. EBRAHIM MAMSA, D.D.S., Case No. 2006-434077 -15- J:\PSU\Medical\Dentistry\David Flynn\Admin Complaints\AC's 02MAY08\mamsa(x)(m).doc

Docket for Case No: 09-001508PL