STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO. 2009-21499 SANTIAGO B. ROLDAN, 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 Respondent, Santiago B. Roldan, 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 15793. 3. Respondent’s address of record is 1501 S.E. 23” Avenue, Pompano Beach, Florida 33062. Filed December 18, 2012 3:42 PM Division of Administrative Hearings 4. Respondent provided dental treatment to Patient M.O. from on or about March 13, 2009, through on or about July 29, 2009. 5. On or about March 13, 2009, Patient M.O. presented to Respondent as a new patient for the purposes of establishing a general dentist-patient relationship. A panorex and two periapicals were exposed. 6. At the March 13, 2009, visit, there were no bite-wings exposed to check for carious lesions or to properly evaluate Patient M.O.'s periodontal condition. 7. There was incomplete documentation in the treatment notes for Patient M.O’s March 13, 2009, visit, concerning charting of existing oral conditions. There was only an “x” by missing teeth. 8. The treatment notes for the March 13, 2009, visit recorded that periodontal probings were done. The treatment notes fail to document a periodontal examination or periodontal diagnosis. 9. The treatment notes for the March 13, 2009, visit failed to document any soft tissue or oral cancer examination. 10. At the March 13, 2009 visit, Respondent proposed a Treatment Plan for Patient M.O. The Treatment Plan consisted of periodontal treatment and a recommendation for ortho. Tooth number 29 was diagnosed as needing -2- J:\PSU\Medical\Dentistry Jeff Peters\ACs10\Roldan09-21499(x)(m).doc endodontic treatment and a build up. There was no other restorative treatment documented. 11. On or about March 25, 2009, Patient M.O. presented back to Respondent for periodontal treatment. Respondent’s progress notes for Patient M.O’s March 25, 2009, visit recorded a prescription for metromidozole, but failed to record a prescription for Ibuprofen 800mg. The progress notes failed to record any reasons for providing the prescriptions to Patient M.O. 12. On or about March 28, 2009, Patient M.O. presented back to Respondent to continue periodontal treatment. The treatment notes recorded that Patient M.O. had tooth number 20 extracted due to, “periodontal involvement.” The Respondent failed to develop a Treatment Plan for this extraction, and the probings show only one 4mm pocket. 13. Respondent failed to obtain Informed Consent from Patient M.O. for the extraction of tooth number 20 on or about March 28, 2009. The treatment notes for this visit also fail to document that any post-operative instructions were given to Patient M.O. 14. On or about April 14, 2009, Patient M.O. presented back to Respondent. Respondent began the treatment of tooth number 29. Tooth J:\PSU\Medical\Dentistry\Jeff Peters\ACs10\Roldan09-21499(x)(m).doc number 29 had been previously treated with a post and a crown. Radiographs maintained by the Respondent show a large periapical lesion. The treatment notes document that Respondent removed the crown and post. Informed Consent was obtained for this procedure. 15. On or about April 27, 2009, Patient M.O. presented back to Respondent. Respondent began Patient M.0.'s endodontic treatment and rubber dam isolation was documented in the treatment notes. 16. On or about May 4, 2009, Patient M.O. presented back to Respondent. The treatment notes documented that Respondent instrumented and obturated the buccal canal. Patient M.O. was given a new appointment for the treatment of the lingual canal. 17. Patient M.O. presented back to Respondent for treatment of the lingual canal on or about June 9, June 15, June 22, and July 20, 2009. 18. On or about July 27, 2009, Patient M.O. presented back to Respondent. The treatment notes documented that Respondent placed some, “sealer on canals” but not a final obturation with gutta percha. Respondent did a core build up and instructed Patient M.O. to wait for four months and see what happens. -4- J:\PSU\Medical\Dentistry\Jeff Peters\ACs10\Roldan09-21499(x)(m).doc 19. The prevailing minimum standard of care in diagnosis and treatment for rendering dental care requires a dentist to perform an adequate comprehensive initial clinical examination of any patient to include an evaluation for pathology, condition of the teeth and TMJ, which should also include findings of decay, periodontal health status with pocket depth probing and charting, the presence and condition of existing restorations, whether there is a need for restorations and any pertinent radiographic findings. After an examination, the dentist should formulate a comprehensive treatment plan with alternatives and present the patient with the treatment plan to ensure full informed consent. On or about March 13, 2009, Respondent failed to perform an adequate initial clinical evaluation of Patient M.O. and failed to meet these required standards. 20. The prevailing standard of diagnosis and treatment for rendering dental treatment requires a dentist to expose bitewing radiographs to check for carious lesions and to properly evaluate a patient’s periodontal condition. The Respondent failed to expose any bitewing radiographs when Patient M.O. presented to his office on or about March 13, 2009. 21. The prevailing standard of diagnosis and treatment for rendering dental treatment requires a dentist to present appropriate options to a patient -5- J:\PSU\Medical\Dentistry\Jeff Peters\ACs10\Roldan09-21499(x)(m).doc in the proposed treatment plan. The Respondent failed to provide appropriate treatment choices to Patient M.O. when he recommended endodontic treatment for tooth number 29 and/or failed to refer Patient M.O. to an endodontist for appropriate evaluation and treatment. 22. The prevailing standard of diagnosis and treatment for rendering dental treatment requires a dentist to develop a Treatment Plan and obtain Informed Consent from a patient prior to proceeding with treatment. The Respondent failed to develop a Treatment Plan and obtain Informed Consent from Patient M.O. before performing an undiagnosed extraction of tooth number 20 on or about March 28, 2009. 23. The prevailing standard of diagnosis and treatment for rendering dental treatment requires a dentist document post operative instructions. The Respondent failed to document that he provided any post operative instructions to Patient M.O. after he extracted tooth number 20 on or about March 28, 2008. The extraction of tooth number 20 was unsupported by Respondent's pocket probings. 24. The prevailing standard of diagnosis and treatment for rendering dental treatment requires a dentist to complete the treatment that he begins to perform on a patient. The Respondent failed to complete the endodontic -6- J:\PSU\Medical\Dentistry\Jeff Peters\ACs10\Roldan09-21499(x)(m).doc treatment on tooth number 29 which he began on or about April 27, 2009. Respondent placed a core on tooth number 29 and decided to wait to see if the tooth is asymptomatic. The endodontic treatment should have been completed or apical surgery should have been done. Placing a crown on a tooth that has incomplete endodontic treatment without an evaluation or treatment by an endodontist does not meet the minimum standards of dental treatment. 25. The prevailing standard of diagnosis and treatment for rendering dental treatment requires a dentist document the reasons for giving a prescription to a patient. The Respondent failed to document in the treatment notes the reason for prescribing metromidozone to Patient M.O. on or about March 25, 2009. 26. The prevailing standard of diagnosis and treatment for rendering dental treatment requires a dentist to record prescriptions given to a patient and document the reasons for giving the prescription to a patient. The Respondent failed to record in the treatment notes a prescription for Ibuprofen 800mg and failed to document in the treatment notes, the reason for prescribing Ibuprofen 800mg to Patient M.O. on or about March 25, 2009. J:\PSU\Medical\Dentistry\Jeff Peters\ACs10\Roldan09-21499(x)(m).doc COUNT I: STANDARD OF CARE 27. Petitioner re-alleges and incorporates paragraphs one (1) through twenty-six (26) as if fully set forth herein. 28. Section 466.028(1)(x), Florida Statutes (2009) provides that “[b]eing 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[,]” shall constitute grounds for disciplinary action by the Board of Dentistry. 29. 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: A. By failing to perform a complete/comprehensive periodontal evaluation of Patient M.O. on March 13, 2009, prior to beginning endodontic work on tooth number 29, including failing to adequately chart existing oral conditions, failing to perform a soft tissue or oral cancer examination, and failing to perform a soft tissue exam; B. By failing, to perform on March 13, 2009, a periodontal examination and/or failing to establish a periodontal diagnosis to support the recommended care; J:\PSU\Medical\Dentistry\Jeff Peters\ACs10\Roldan09-21499{x)(m).doc Cc. By failing to expose bitewing radiographs on March 13, 2009, to check for carious lesions and to properly evaluate Patient M.0.’s periodontal condition; D. By failing to present Patient M.O. with a Treatment Plan and/or appropriate treatment options for tooth number 20. Extracting tooth number 20 on March 28, 2009, prior to a diagnosis and prior to addressing treatment options with Patient M.O. was not acceptable treatment; E. By failing to obtain Informed Consent from Patient M.O. on March 28, 2009, before extracting tooth number 20; F. By failing to complete endodontic treatment and/or performing apical surgery on tooth number 29; G. By failing to refer Patient M.O. to an endodontist for appropriate evaluation and treatment of tooth number 29; and/or H. By placing a core and on tooth number 29 and waiting to see if the tooth is asymptomatic was not acceptable treatment. 30. Based on the foregoing, Respondent has violated Section 466.028(1) (x), Florida Statutes (2009), 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 or experience or being guilty of dental malpractice. J:\PSU\Medical\Dentistry\Jeff Peters\ACs10\Roldan09-21499(x)(m).doc COUNT II: RECORD KEEPING 31. Petitioner re-alleges and incorporates paragraphs one (1) through twenty-six (26) as if fully set forth herein. 32. Section 466.028(1)(m), Florida Statutes (2009), provides that “[flailing 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. Rule 64B5-17.002, Florida Administrative Code, further provides that for purposes of implementing Section 466.028(1)(m), a dentist shall maintain written records on each patient which written records shall contain, at a minimum, the 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. -10- J:\PSU\Medical\Dentistry\Jeff Peters\ACs10\Roldan09-21499(x)(m).doc 33. Respondent failed to keep written dental records and medical history records justifying the course of treatment of Patient M.O. in one or more of the following ways: A. By failing, on or about March 13, 2009, to adequately document Patient M.O.'s presenting conditions. The tooth charting of existing conditions was incomplete and only had an “x” by missing teeth. There was no documented Periodontal Examination or periodontal diagnosis before initiating treatment; B. By failing, on or about March 13, 2009, to document oral cancer and/or soft tissue examination; c. By failing, on or about March 25, 2009, to document in the treatment notes the reason for prescribing Metromidozole and Ibuprofen 800 mg; D. By failing, on or about March 25, 2009, to document in the treatment notes a prescription for Ibuprofen that was given to Patient M.O.; E. By failing to document in the treatment notes, on or about March 28, 2009, any examination and/or discussion with Patient M.O. concerning problems associated with tooth number 20, prior to the extraction of tooth number 20; F. By failing to document in the treatment notes on or about March 28, 2009, a Treatment Plan for the extraction of tooth number 20; G. By failing to document in the treatment notes on or about March 28, 2009, Informed Consent from Patient M.O. prior to extracting tooth number 20; and/or -t1i- J:\PSU\Medical\Dentistry\Jeff Peters\ACs10\Roldan09-21499(x)(m).doc H. By failing to document in the treatment notes on or about March 28, 2009, any post-operative instructions given to Patient M.O. Based on the foregoing, Respondent has violated Section 466.028(1)(m), Florida Statutes (2009), by failing to keep written dental records and medical history records justifying the course of treatment of Patient M.O. WHEREFORE, Petitioner respectfully requests that the Board of Dentistry 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 collected, remedial education and/or any other relief that the Board deems appropriate. J:\PSU\Medical\Dentistry\Jeff Peters\ACs10\Roldan09-21499(x)(m).doc SIGNED this G2:/ day of ) ia \ 2011. i H. Frank Farmer, Jr, MD, PhD, FACP State Surgeon General Too al Jeff G. Peters Assistant General Counsel -~ DOH Prosecution Services Unit FILED 4052 Bald Cypress Way, Bin C-65 DEPARTMENT RK Tallahassee, FL 32399-3265 CLERK Angel Sanders Florida Bar No. 718343 DATE JUL 25 2011 850.245.4640 850.245.4683 FAX PCP: 7-22-11 PCP Members: (1/7) JT tWR DOH v. Santiago B. Roldan, D.D.S.; Case # 2009-21499 -13- J:\PSU\Medical\Dentistry\Jeff Peters\ACs10\Roldan09-21499(x)(m).doc 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. Santiago B. Roldan, D.D.S.; Case # 2009-21499 -14- J:\PSU\Medical\Dentistry\Jeff Peters\ACs10\Roldan09-21499(x)(m).doc

Docket for Case No: 12-004110PL