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STATE OF FLORIDA DEPARTMENT OF HEALTH

DEPARTMENT OF·HEALTH,

PETITIONER,

v.

CASE NO, 2007·32408

Leonard Badger, DDS,

RESPONDENT.

ADMINISTRATIVE COMPLAINT

COMES NOW Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Dentisby against Respondent, Leonard Badger, DDS, 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 13942.

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3. Respondent's address of record is 7009 Dr. Philips Boulevard, Suite #200, Orlando, Florida 32819.

'ii' 4. Respondent provided dental treatment to Patient KW from on or

about December 18, 2000, through on or about May 21, 2007.

1. On or about December 18, 2000, Patient KW presented to the Respondent as a new patient. The Respondent performed a new patient examination, took 4 bite wing x-rays and presented a treatment plan to Patient KW for a comprehensive rehabilitation of the patient's mouth.

2. Patient KW indicated that the patient would not be able to start

   the treatment plan right away. Before initiating the plan Patient KW presented for regular prophy examinations and for treatment of the patient's periodontal disease.

3. On or about October 16, 2003, the Respondent documented that he explained to Patient KW that the priority of the treatment plan was to place crowns on tooth numbers 6 and 14 before delivering the new partial

   ;· denture.

   
   

   
   

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4. On or about December 29, 2004, Patient KW presented to the Respondent to have teeth numbers 6, 7, 8, and 9 prepared for crowns. The

   •· i: Respondent took final impressions and placed temporary crowns on the

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   teeth.

   
   

5. On or about January 5, 2005, Patient KW presented to the Respondent with complaints of sensitivity.

6. On or about January 13, 2005, Patient KW presented to the Respondent with continued complaints of sensitivity. The Respondent took impressions with the crowns in place for partial denture framework.

7. Patient KW presented on or about January 31, 2005, for a metal try-in of the partial denture with the crowns in place. Patient KW reported that the patient's teeth were very sensitive.

8. Patient KW presented on or about March 2, 2005, for gross debridement. The treatment note reflects that the patient's hygiene was improving and the patient presented with light plaque and bleeding.

: · .· '13. · On or about March 2, 2005, Patient KW presented for delivery of the partial and crowns. The Respondent was unable to deliver the partial t)ecause the framework would not fit into the patient's mouth. The Respondent took new impressions. Patient KW presented on or about March 23, 2005, for metal try-in and wax bite registration.

1. Patient KW presented on or about March 28, 2005, with a chief

   
   

   ,. ''(

   complaint of pain on tooth number 9. Patient KW's tooth number 9 was

   
   

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   tender to percussion, nonmobile and had no suppuration. The Respondent

   
   

   I"'

   
   

   took one periapical x-ray. The Respondent diagnosed tooth number 9 with irreversible pulpitis/pulpal necrosis. The Respondent recommended and performed root canal therapy on tooth number 9. The Respondent documented explaining the risks, benefits and potential complications associated with root canal treatment.

2. On or about April 6, 2005, the Respondent delivered splinted crowns for teeth numbers 6, 7, and 8. The Respondent cemented the crowns with Fuji cement. The Respondent completed root canal therapy on tooth number 9 and took a post-operative x-ray.

3. On or about April 11, 2005, Patient KM presented to the

   
   

   ,,", Respondent to have the permanent crown on tooth number 6 recemented

   
   

   with.Fuji cement.

   
   

   1?, On or about April 27, 2005, Patient KM presented to the Respondent after the crown on tooth number 7 came loose and the patient began to choke on the crown. The Respondent agreed to remake the crowns on teeth numbers 6, 7, 8, and 9 and splint the crowns together.

   
   

   ,1,

   The Respondent explained that loosening of temporaries and permanent crowns could occur since the patient had no posterior teeth and retention

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   would improve once the Respondent delivered the final partial.

   
   

   1. Patient KW presented to the Respondent on or about May 5,

      
      

      
      

      ,n, '

      2005, because the crown on tooth number 7 had come off. Patient KW's tooth number 7 was very sensitive to cold. The Respondent removed the crowns on teeth numbers 6, 8 and 9, took new impressions and a bite registration.

   2. On or about May 25, 2005, the Respondent delivered the partial bridge from tooth number 6- tooth number 9 and the precision fit upper partial denture to Patient KW. Patient KW presented again to the

      ,, '

      ' 1 Respondent on or about May 26, 2005, for a post-op appointment. The

      
      

      1 ,, Respondent made adjustments to the partial.

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   3. On or about March 6, 2007, Patient KW presented with severe pain in the upper right side. The Respondent took 1 periapical x-ray. The

      ;;; Respondent noted tooth number 7 was tender to percussion and palpation. The Respondent recommended Patient KW receive endodontic treatment on tooth number 7 which would be performed through the existing crown.

      ,, The Repondent performed the root canal treatment.

      
      

   4. On or about March 19, 2007, Patient KW presented for the final obturation appointment. The Respondent noted the porcelain on the facial

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side of the adjacent crown on tooth number 6 was chipped.

22.· On or about April 3, 2007, the Respondent unsuccessfully attempted to remove the bridge from tooth number 6-tooth number 9. The Respondent then elected to section the bridge at the crown of tooth

number 6, fabricate individual crowns on tooth numbers 7, 8, and 9 and a new Valplast partial. The Respondent noted that the removal of the crown on tooth number 6 necessitated a new post and build up.

1. On or about April 25, 2007, the Respondent delivered the crown

   
   

   ,. on°"tooth number 6 and cemented it with Fuji cement. The Respondent noted that a final set was not achieved. As a result, the Respondent would have to remove and replace the post.

2. On or about May 2, 2007, Patient KW presented with

   
   

   complaints that tooth number 6 was loose and the patient experienced a sharp pain around tooth number 9. The Respondent took periapical x-rays of the areas around tooth number 6 and tooth number 9. The Respondent

   documented that he explained that the patient could have a possible fractured root on number 9 and the post on tooth number 6 was fractured

   
   

   .1,.

   from a previous visit. The Respondent modified the treatment plan to include the extraction of tooth number 9, fabrication of a bridge from tooth

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   number 7- tooth number 11 and the extraction of tooth number 6 with a cosmetic thermoplastic partial replacing it.

3. On or about May 3, 2007, Patient KW presented for a

   
   

   t::onsultation regarding plans to extract tooth number 9 due to a possible frac ure/failed root canal. The Respondent noted that he explained the reasons for the changes in the treatment plan, to remove the crown and

   ·•; bridge work and extend the bridge to tooth number 11, were to aid in the

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   ;," retention and stability of the bridge.

   
   

4. On or about May 8, 2007, the Respondent removed the crowns on teeth numbers 6-10. The Respondent's examination of tooth number 6

   revealed that the root was not mobile; and there was no visible fracture on

   the x-ray or any clinical signs of a fracture. The Respondent determined

   that no extraction was needed but advised the patient's aunt of the potential for further complications because of the patient's lack of posterior

   }1,

   /, teeth. The Respondent placed new posts in tooth numbers 6 and tooth

   Y , number 7. The Respondent did not take any radiographs on this date.

   
   

   
   

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5. On or about May 8, 2007, the Respondent prepared teeth n,umbers 6, 7, 8, 10 and 11 for crowns and took final impressions. Examination of tooth number 9 revealed a vertical fracture in middle third

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   ;: of the root. Consequently, the Respondent extracted tooth number 9. The Respondent placed a temporary bridge from tooth number 6-tooth number 11..

6. On or about May 17, 2007, Patient KW presented to the

   
   

   Respondent with complaints of sensitivity to cold, inability to eat and a missing temporary crown on tooth number 12. The temporary crown was repaired. This was the last time Patient KW presented to the Respondent for treatment.

7. On or about May 17, 2007, . Patient KW presented to an

   
   

   •... ·endodontist for a consultation regarding teeth numbers 12, 11, 10, 8, 7,

   L

   and 6. The endodontist noted that Patient KW presented with chronic and

   
   

   . acute ·pain. In addition, Patient KW exhibited periapical tenderness to palpation to all endodontically treated teeth.

8. The radiographs taken by the endodontist on May 17, 2007, revealed that the post placed in tooth number 7 was placed outside the root canal space. The radiographs also showed that tooth number 6 had two posts, one that appeared to have perforated the root.

9. The standard of care for a dentist placing a post is to prepare the canal and cement the post in the prepared root canal space. If complications

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   such as a root perforation or if the post is cemented outside the root canal space, the dentist should inform the patient of the complication. The dentist should also explain the treatment options and the risks and benefits associated with the various treatment options and/or refer the patient to an endodontist.

10. The Respondent failed to notify Patient KW that the post had been placed outside the root canal path and to advise the patient of the f risks and complications assodated the post placement.

33. The Respondent failed to explain the treatment options for a

: .·.·. misplaced post and the risks and benefits associated with the various

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treatment options and/or refer the patient to an endodontist.

1. The Respondent's failure to take a post operative x-ray following the placement of the posts on tooth numbers 6 and 7 resulted in the Respondent's failure to diagnose potential root perforations in either tooth and to appropriately inform the patient and/or refer the patient to an endodontist.

   COUNT I

   
   

2. Petitioner realleges and incorporates paragraphs one (1)

   
   

   through thirty four (34) as if fully set forth herein.

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3. Section 466.028(1)(m), Florida Statutes (2000-2006), 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 disciplinary action by the Board of Dentistry.

37.. Rule 64B5-17.002(1), Florida Administrative Code requires that: for the purpose of implementing the provisions of subsection 456.028(1)(m), Florida Statutes, a dentist shall maintain written records on

...".

each patient which written records shall contain, at a minimum, the

r following information about the patient:

1. Appropriate medical history;

2. Results of clinical examination and tests conducted, including the identification, or lack thereof, of any oral pathology or diseases;

3. Any radiographs used for the diagnosis or treatment of the patient;

4. Treatment plan proposed by the dentist; and

5. Treatment rendered to the patient.

1. Respondent failed to keep written dental records and medical history records justifying the course of treatment of the patient in one or more of the following ways:

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   1. By failing to maintain laboratory prescriptions for the crowns and/or bridge for Patient 'f0/V;

   2. By failing to document complications the Respondent had when providing endodontic treatment to Patient 'f0/V's tooth number 7; and/or,

   3. By failing to maintain a post operative x-ray of the endodontic treatment performed on tooth number 6 and/or 7.

2. Based on the foregoing, Respondent has violated Section

   
   

   
   

   ' (,

   . ,•

   466.028(1)(m), Florida Statutes (2000-2006), by failing to keep written dental records and medical history records justifying the course of

   treatment of Patient 'f0/V,

   
   

   COUNT II

   
   

3. Petitioner realleges and incorporates paragraphs one (1) through thirty four (34) as if fully set forth herein.

4. Section 466.028(1)(x), Florida Statutes (2000-2006), provides that being guilty of incompetence or negligence by failing to meet the rriinimum 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.

   ' '

5. Respondent failed to meet the minimum standards of

   
   

   ,, , performance in diagnosis and treatment when measured against generally prevailing peer performance in one or more of the following ways:

   1. By placing a post outside the root canal treatment space in tooth number 7;

   2. By failing to notify Patient KW that the post had been placed outside the root canal path and advise the patient of the risks and complications associated with the post placement;

   3. By failing to retreat tooth number 7 after placing the post outside the canal and/or refer the patient to an endodontist for treatment; and/or,

   4. By failing to take a post operative x-ray following the placement of the posts on tooth numbers 6 and 7, the Respondent failed to diagnose potential root perforations in tooth number 6 or

      7 and to appropriately inform and/or refer the patient to an endodontist.

6. Based on the foregoing, Respondent has violated Section 466.028(l)(x), Florida Statutes (2000-2006), 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 treatment for which the dentist is not qualified by training

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or experience or being guilty of dental malpractice.

· VVHEREFORE, Petitioner respectfully requests that the Board of

D2ntistry enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of Respondent on probation, corrective action, refund of fees billed or collectedt remedial education and/or any other relief that the Board deems appropriate.

SIGNED this   4-=-=t""'""h_ day of December I 2009,

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PCP: /.;./'I-/ t Cf

PCP f·llernbers: C NI, IN v. F r;,

f=ILED

DEPARTMENT OF HEALTH

DEPUi'I CLERK

CLERK:{' / V

CA--:;" / ,'.71· )-0 '1

Ana M. Viamonte Ros, M.D., M.P.H State Surgeon General

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/; }<

1

, o t:tu:;o,. D-i

Patricia D. Smith Assistant General Counsel

DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar No. 728160 850.245.4640

850.245.4683 FAX

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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

-tepresei::ited by counsel or . other qualified representative, to present

ii\1 l dence 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.

',I

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 Leonard Badger; case # 2007-32408

;..-,_.

Docket for Case No: 11-002465PL