Findings Of Fact Respondent, Dr. John R. Parry, at all times pertinent to this hearing, was licensed by the State of Florida to practice dentistry under License No. DN- 0005282. His primary practice is at the Florence Denture Clinic, located at 255 Wymore Road, Winter Park, Florida, but he also operates several other clinics under the same name in Jacksonville and St. Petersburg, Florida. In late February, 1981, Nancy Bradley, a 28-year-old married woman living in Leesburg, Florida, was experiencing extreme pain due to an abscessed tooth. She had tried to get dental treatment in her hometown, but for some reason was unable to do so, so she requested that her sister, Leslie Wilson, who lives in Orlando, get an appointment for her with a dentist in that area. Ms. Wilson contacted Respondent's Winter Park clinic and made an appointment for Ms. Bradley for February 27, 1981. During the course of her conversation with the receptionist, she was quoted the price for various services provided by the clinic. She called this clinic because she had been treated there before and it was the only place she knew that was reasonable. On February 27, 1981, Ms. Bradley and Ms. Wilson went to Respondent's clinic early in the morning. Ms. Bradley told the receptionist she had a bad tooth, filled out some forms, paid $180 in advance, and was told to wait. At this time, even though early in the morning, the waiting room was crowded. After a wait of approximately 30 minutes, she was called in for X rays and afterwards, after a wait of an additional five minutes or so, was taken into the work area. She described this area as a large room broken up by partitions into separate work stations. After being put in the chair, she waited for a few minutes until a man she identified later as Wayne Giddens came in and took a molded impression of her mouth. She described the man in question and heard him referred to by others as Wayne. Her description fits that of the Wayne Giddens who testified at the hearing. After Giddens left, Respondent came in and examined her mouth, telling her she needed to have four teeth pulled. Ms. Bradley told Respondent to pull only those teeth which could not reasonably be saved. Respondent did not tell her which teeth would have to be pulled. At this point, Ms. Wilson, who was also present, started asking questions as to why the teeth could not be saved. Respondent became upset by these questions, told Ms. Wilson to leave, threw the X rays down on the tray and told Ms. Bradley that if he did not pull the teeth, he would not do anything. When she acquiesced, he told her to come back at 2:00 that afternoon. Because she had already paid for the treatment, because she was in much pain from her teeth, and because she thought the doctor knew what he was talking about, she came back as instructed and was taken into another room for treatment. This time her sister, Ms. Wilson, remained in the waiting room. When Ms. Bradley was seated, a different dentist from Respondent came in and, after quickly looking at her chart, gave her an injection of anesthetic. Almost immediately and before the injection had a chance to take effect, this dentist started to pull her teeth. It hurt badly, and she asked for more anesthetic, which the doctor administered, and again began to pull her tooth. Partly through the procedure, however, he stopped, called someone on the phone that was there, and asked why an oral surgeon had not been called in. Apparently satisfied with the answer he received, he returned to the patient and finished the extraction. After the first tooth was removed, the doctor started to pull a front tooth. Ms. Bradley asked why he was pulling there, when her pain was in the back. The attending dentist said it was because Respondent, Dr. Parry, bad said so. The attending dentist, however, indicated his opinion that the extraction of the front tooth was questionable. A total of four teeth were pulled from Ms. Bradley's mouth that day. These were teeth numbered 3, 9, 10, and 12. Aside from the initial comment to Respondent requesting that any teeth that could be saved not be pulled and her question to the attending dentist, Ms. Bradley did not raise any objection to the extraction of her teeth. She indicated that she trusted the doctor involved, and since she had come in to seek relief from an abscess, in light of her prefatory comments, she felt that if teeth were pulled, they had to be pulled. In fact, she signed a consent form numbered 1083, which refers to an attached Information Sheet. Ms. Bradley does not recall having seen the information sheet, but no doubt was furnished one. However, review of the information sheet shows the "procedures outlined" are not at all clearly defined. In fact, it is more in the form of a disclaimer and cannot in any reasonable way be considered as forming the basis for an informed consent. Consequently, it is clear that the procedures undertaken by Respondent and his staff were not based on a full and informed consent by the patient, Ms. Bradley. After the teeth in question were pulled, Ms. Bradley was taken into another room, where she was put in a chair. At this point, though her mouth was still bloody from the extractions, the same individual who took the impressions earlier in the day came in with the dentures and inserted them in her mouth. He told her to leave them there for 24 hours and not to eat for the period, and left. Ms. Bradley was then led out to the waiting room, where her sister met her. Ms. Wilson was quite upset by the condition of Ms. Bradley and, after taking her to the car, immediately went back into the clinic to talk with someone about the situation. When she asked for Respondent, she was told that he and all other dentists were gone for the day. A few days later, Ms. Bradley went to another dentist, Dr. Rucher, who treated her for four dry sockets, where the teeth had been pulled, and a gum infection. He also made a new partial bridge for her to replace the one made at Respondent's clinic, which device did not fit properly. She did not return to Respondent's clinic. Mr. Giddens, the individual who took the impression of Ms. Bradley's mouth and who placed the completed bridgework in, is not a licensed dentist, but is a dental technician and has been for approximately 14 years. He has had no formal schooling for his work and has secured all his knowledge through on-the- job training. With the exception of a three-month hiatus in the summer of 1982, he has worked for Respondent since 1980. He primarily works in quality control, inspecting dentures when they come from the laboratory. His duties do not include taking impressions of patients' mouths or the fitting of dentures. These are functions performed by others in the office. He denies having put any dentures in Ms. Bradley's mouth. If he were to do so, he states, Respondent would fire him. The dental chart on each patient contains the initials of the individual who actually accomplished the work. For example, the chart on Ms. Bradley shows that on February 27, 1981, the examination and the X rays were performed by "P," which stands for "Parry." The delivery of the dentures is noted by the initials "WG." Mr. Giddens' first name is Wayne. Therefore, since Ms. Bradley positively identified Mr. Giddens as the individual who took the impression of her mouth and later inserted the denture, since she called him by name from overhearing his name mentioned by others in the clinic while the work was being done, and since the witness alone initialed the records denoting delivery of the dentures, it is found that Mr. Giddens did, in fact, do both, as alleged. As was previously found, four teeth were pulled from Ms. Bradley's mouth at Respondent's clinic on February 27, 1981. These teeth were identified on her dental chart as Nos. 3, 9, 10, and 12. Several experts in the field of dental surgery examined the X rays that were taken of Ms. Bradley's mouth at Respondent's clinic on the day of her visit, but before the extraction. This X- ray picture shows clearly the condition of teeth numbered 9, 10, and 12. It was the consensus of all experts that teeth numbered 9 and 10 were not in such deteriorated condition that they needed to be pulled. A reasonable amount of restoration work by a competent dentist could have saved these two teeth. It was also the consensus that tooth numbered 12 was not reasonably salvageable and was properly extracted. Because of the location of tooth numbered 3 and the quality of the X ray, no firm opinion was reached by the experts with regard to this tooth. Therefore, it is found that of the four teeth pulled, two, Nos. 9 and 10, could have been saved by the use of root canal and crown work, a reasonably simple procedure which was available, but considerably more costly than the extraction and bridgework. Ms. Bradley indicated that while she has paid little attention to her mouth and tooth condition prior to this episode, and that while her mouth, at the time in question, was not in good shape and did not reflect good dental hygiene practices, she would have paid what was necessary to save her teeth. There are numerous factors for a patient to consider before making a decision to have teeth extracted. Among these are: The willingness to have it done with the knowledge that once the tooth is gone, it is forever. The patient's dental I.Q.--the willingness of the patient to practice good dental hygiene afterwards. The cost of restoration versus extraction. The pain and inconvenience to the patient, recognizing that restorative treatment may require several visits while extraction is done in one visit. Generally speaking and based on these considerations, most dentists believe it is better to save a tooth than to extract it. With that in mind, it is generally considered to be practice below minimum community standards not to advise a potential extraction patient of available alternative treatments. It is up to the patient, then, to make the decision whether to extract or not, after being provided with all reasonable available information. If there is a proper informed consent given by the patient, then an extraction of even salvageable teeth would not be practice below minimum standards. However, if a dentist pulls a restorable tooth without informing the patient of alternative treatments, since any taking of patient tissue is serious, this action would fall below community standards. The standards stated above are no different for a high-volume clinic practice than for a routine practice. All elections of the patient, including the fact that the patient was advised and declined alternate treatment, should be made a part of the patient records. Here, the records kept by Respondent reflect no advice as to alternatives nor an election as to treatment. The "consent" form utilized by Respondent is totally insufficient to establish informed consent. Respondent did not authorize Mr. Giddens to either take the impression of Ms. Bradley's mouth or insert the appliance. To do either would be the unauthorized practice of dentistry. It is his policy that technicians do not get into a patient's mouth, particularly in the case of partial bridgework, where the fit is critical. He does not recall Ms. Bradley nor is she listed in his appointment book for the date in question. This latter factor, he states, indicates she came in either as a walk-in, or was fit in as a favor to her sister, already a patient at the clinic. As to the payment, she could not have had a fee set until it was determined what action would be taken. Also, Ms. Bradley was patient number 17 for the day. Respondent states this shows she did not come in early, but more like 8:30 or 9:00 a.m. All of these factors are claimed by Respondent to show that Ms. Bradley is not being truthful in her allegations. However, this has not been shown. Respondent, in one statement, says he does not recall this patient, nor does he recall throwing the X rays on the table and stalking out of the office. However, he contends she asked him to take out the four teeth in question. Based on the state of the evidence, Ms. Bradley is the more credible witness.
Recommendation Based on the foregoing, it is RECOMMENDED: That Respondent pay an administrative fine of $2,000 and be reprimanded. RECOMMENDED this 13th day of October, 1983, in Tallahassee, Florida. ARNOLD H. POLLOCK, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 6th day of October, 1983. COPIES FURNISHED: Julie Gallagher, Esq. Department of professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Thomas Infantino, Esq. Post Office Drawer 30 Winter Park, Florida 32790-0030 Mr. Fred Roche Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Mr. Fred Varn Executive Director Board of Dentistry Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
The Issue The issues to be resolved in this proceedings concern whether the Petitioner is entitled to receive a passing score on the December 1999 dental licensure examination.
Findings Of Fact The Petitioner, Carlo Coiana, was an unsuccessful candidate for the December 1999 dental licensure examination. He failed to pass several procedures of that licensure examination, according to the Department's graders and grading method. The December 1999 dental licensure examination consisted of two parts: (1) The clinical, and (2) The laws and rules section. The clinical portion consists of nine different procedures of which the Petitioner challenged six. The Department, in is scoring method, selects three examiners to grade each candidate's performance. The average of the three scores from each examiner, produces the overall grade for that procedure. Rather than having only one examiner score, the Department allows for three examiner scores because this provides a more fair, reliable indication of the candidate's competency and true score. Each examiner must be a licensed dentist for a minimum of five years and have no complaints or negative actions on his or her licensure record. Each examiner must also attend and successfully complete a standardization session which trains each examiner to use the same internal grading criteria. The examiners who graded the Petitioner's examination successfully completed the standardization session and training. During the administration of the dental examination the Department requires the use of monitors who are also licensed dentists. The monitor's role is to preserve and secure the integrity of the examination. The monitor also gives instructions to each candidate as to what to expect. The monitor has no part in the grading of the candidate's performance on the examination but acts as a messenger between the candidate and the examiner since there is a "double-blind" grading of the examination. The Petitioner contested the score he received on the Class II Composite Restoration on a model. The Class II Composite Restoration Portion of the examination is a procedure involving restoring a cavity (Class II) preparation with a tooth-colored filling. The procedure was done by the Petitioner with a comment by the examiners that there was a discrepancy in the resulting shape of the tooth and proper contact to the adjacent tooth. There was also a marginal discrepancy and a "gingival overhang." The margin is where the tooth and filling meet and there was a discrepancy felt there, a bump or a catch when the junction of the two surfaces should be smooth. A gingival overhang is in the area between the tooth where a non- smooth transition between the filling and the tooth is detected. This can be a damning area which will collect plaque and lead to re-current decay. The Respondent's expert, Dr. John Joffre, concurred with the overall findings of the examiners and felt that this procedure should not be accorded a passing score but rather the score accorded by the examiners. The Petitioner also contested the score for procedure number four of the examination, the Endodontic procedure. The Endodontic procedure of the examination is referred to as a "root canal." This procedure involves removal of the nerve and blood vessels inside a tooth in order to clean out that area. It then requires the shaping of the canal and, finally, filling it with an inert material to rid the body of the infected area in question. This procedure is performed on an extracted tooth. The minimum of the working length the Department required in order to receive a passing score for the filled material in the tooth in question was two millimeters. The Petitioner's expert had the working length of the filled area in the root canal or Endodontic procedure done by the Petitioner measured. It measured closer to three millimeters which is totally unacceptable according to Dr. Joffre. Even in accordance with the literature that the Petitioner relied upon in this case it is not provided that three millimeters short of the working length is an accepted working length, which is why the Petitioner received less than a passing score. All three examiners and the expert witness Dr. John Joffre were in agreement about this scoring. Three millimeters short of the required working length will cause the procedure to definitely fail sometime in the future and renders the procedure useless. An Endodontically treated tooth that is three millimeters short will fail clinically, and that justifies a failing grade on this procedure. The next procedure contested by the Petitioner as to score was the Amalgam Restoration done with a model. This procedure is similar to the Class II Composite Restoration. However, the difference between the two procedures is that the Amalgam is referred to as a silver filling containing mercury, silver, etc., as opposed to the Composite material in the above- referenced procedure which is a "tooth-colored" restoration. Although the Composite and the Amalgam serve the same function, they require different tasks and different procedures on how they are to be handled in their installation in the mouth. The major problem found with the Petitioner's performance on this procedure concerned an overhang. As referenced above, a gingival overhang at the margin of where the filling and the tooth meet results in a less than smooth transition and can be an area where food accumulates and decay can start anew. All three examiners also noted a problem with the proximal contour of the Amalgam restoration which has to do with the shape of the filling in terms of how it meets the tooth next to it. The testimony of Dr. Joffre, which is accepted, shows that the examiners comments and grades and Dr. Joffre's opinion itself justifies the scoring on this procedure. Dr. Joffre agrees with the examiners' scoring. The last procedures in question are called the "Patient Amalgam." These procedures, two and three, involve cutting of the tooth before the filling is actually placed into it ("cutting the box"). Procedure three is the actual filling, involving scoring what the filling is like after the filling procedure is completed. The criticism found by both examiner 304 and 346, as to the first part of the procedure, the cutting part, was ". . .did not break the gingival contact, subject to recurrent decay." The gingival contact down in the box cut for the filling must be cut deep enough to reach the point where there is a separation between the edge of the box and the adjacent tooth. Halfway down the tooth, towards the gum, the teeth are still touching. As one progresses further down toward the gum, the teeth separate because they naturally get narrower toward the gum line. A dentist needs to cut the box that the filling should be placed in down far enough toward the gum line so that he gets to the point where the teeth are no longer touching. Both dentists 306 and 346, examiners, found that he did not cut the box low enough so that he "didn't break gingival floor contact with the molar" (meaning the adjacent tooth). Thus, these examiners gave the Petitioner the lowest grade of "one" on that part of the procedure. The filling or restoration portion of the procedure failed. The filling was not adequately carved or shaped so that it was protruding too high above the adjacent tooth surfaces. This caused the patient to break the filling very shortly after it was finished and he was biting downward and putting pressure on it. Indeed it broke while the third examiner was examining the procedure. The reason why the fracture in the filling occurred was because it protruded too high. The Petitioner did not adequately reduce the size or height of the filling, so when the teeth came together the tooth below it or above it was hitting too hard against that one spot and caused the metal to break before the patient, on whom the procedure was done, ever left the building. The Respondent's expert, Dr. Joffre, who agreed with examiners comments and score, found that the Petitioner had failed to properly perform these procedures and that his score had been appropriately arrived at by the examiners. The Petitioner contested the score he received on the Fixed Partial Denture Procedure. The Department ultimately conceded that he should be awarded additional points on that procedure, however, even with the additional points awarded the Petitioner still failed to score adequately on the overall examination for passage, although he came close, with a score of 2.92 out of a minimal score of 3.00 required for passage of the examination.
Recommendation Having considered the foregoing Findings of Fact and Conclusions of Law, the evidence of record and the pleadings and arguments of the parties, it is RECOMMENDED: That a Final Order be entered dismissing the Petition challenging to the grades assigned the Petitioner for the December 1999 Dental Licensure Examination and finding that the Petitioner failed to pass that examination. DONE AND ENTERED this 9th day of February, 2001, in Tallahassee, Leon County, Florida. P. MICHAEL RUFF Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 9th day of February, 2001. COPIES FURNISHED: Carlo Coiana N1 Via Delle Coccinelle Cagliari, Italy 09134 Cherry A. Shaw, Esquire Department of Health Office of the General Counsel 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1703 Theodore M. Henderson, Esquire Agency Clerk Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1703 Dr. Robert G. Brooks, Secretary Department of Health 4052 Bald Cypress Way, Bin A00 Tallahassee, Florida 32399-1703 William W. Large, General Counsel Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701
The Issue Whether the Petitioner should receive on the the clinical portion of the examination additional credit, which is sufficient to receive a passing grade on the December 1997 dental licensure examination.
Findings Of Fact Petitioner, Neda Raeisian, was a candidate for the dental licensure examination administered by the State of Florida in December 1997. The dental examination administered in December 1997 consisted of three parts: a "Florida Laws & Rules" part, an "Oral Diagnosis" part, and a "Clinical" part. The Petitioner received passing scores on the "Florida Laws & Rules" and "Oral Diagnosis" parts of the examination. Petitioner received a score of 2.95 on the Clinical part of the examination. A score of 3.00 was required on the Clinical part of the examination. The Petitioner failed the Clinical portion by .05 of a point, and, therefore, she failed the overall dental examination. Three examiners grade each candidate's clinical portion of the dental examination. Three examiners are used because by averaging the scores of the three examiners, the Respondent is more likely to capture the candidate's true score than by using one or two examiners. Before an examiner may be used for an examination, he or she must be recommended by an existing examiner or by a member of the Board of Dentistry. The proposed examiner may not have any complaints against his or her license and he or she must have been actively practicing and licensed for at least five years in the State of Florida. The examiner must complete an application that is sent to the Board of Dentistry examination committee, where it is then reviewed by the committee, and if approved, the examiner is entered into the pool of examiners. Before every examination, the Respondent conducts a standardization session, which is a process by which examiners are trained to grade using the same internal criteria. The Respondent uses assistant examiner supervisors who are appointed by the Board to train examiners on the different criteria that are used during the examination. The assistant examination supervisors go through and describe what a score of five would be, all the way down to a zero, the different criteria for each of those particular grades, and under what circumstances those grades should be given. After the examiners go through a verbal training, they are shown slides of teeth and told what the score on that procedure should be. After the standardization, there is a post- standardization exercise where the examiners are required to grade five mannequin models to make sure they have been able to internalize the criteria. After the post-standardization exercise, the Respondent evaluates the examiners to determine whether they are acceptable to use during the examination. There are also post-examination checks on the examiner, whereby the Respondent decides whether or not to use the examiners again. The Respondent runs the post-examination statistical checks to make sure that the examiners grade with consistency and reliability. There is generally a very high agreement rate between the examiners. Typically if there is an inconsistency in grading, it is usually the examiner who gives the higher grade that is incorrect because he or she missed an error; any error found by an examiner must be documented. The examiners grade the examination independently of each other; that is, they do not confer with each other while scoring the examination. The examination is also double-blind graded. Double- blind grading is the process through which examiners have no contact with the candidates. The examination is conducted in such a way that there is one clinic that is monitored by a licensed dentist in which the candidates actually perform the procedures. When the candidates are finished a proctor walks the patient over to another clinic where the examiners are located, and the examiners grade the examination. The candidates perform the patient portion of the examination on human beings that they are responsible for bringing in. If the patient has the necessary characteristics, the patient could serve for two different candidates or on two different examinations. The examination is a minimum competency examination. The grading system used during the clinical portion of the examination is as follows: A zero is a complete failure, a one is unacceptable dental procedure; a two is below minimally acceptable dental procedure; a three is minimally acceptable procedure, which is the minimum required to pass the clinical portion; a four is better than minimally acceptable dental procedure; and a five is outstanding dental procedure. An overall score is determine by averaging the three examiners' scores on the eight clinical procedures, putting different weights into a formula, and calculating the final grade. It is required in Board rule that the scores of the examiners be averaged. The Petitioner challenges the score given to her for her performance on Procedure 03, "Amalgam Final Restoration," of the Clinical portion of the examination. The Petitioner performed Procedure 03, the "Amalgam Final Restoration," on a live patient, Ms. Desiree Peacock. The Petitioner's performance on Procedure 03 was graded by three examiners: examiner number 290, identified as Dr. Richard Tomlin, of Pinellas Park, Florida; examiner number 299, identified as Dr. Haychell Saraydar, of Pinellas Park, Florida; and examiner number 176, identified as Dr. Leonard Britten, of Lutz, Florida. The Petitioner received a grade of 4 on a scale of 0-5 for her performance on Procedure 03 by examiner number 290; and a grade of 3 on a scale of 0-5 for her performance on Procedure 3 by examiner number 299. However, she received a grade of 0 on a scale of 0-5 for her performance on Procedure 03 by examiner number 176. The reason the Petitioner was given a score of 0 on procedure 03 by examiner number 176 was that the examiner felt that there was a lack of contact at the amalgam restoration site. The Respondent's dental expert, Jorge H. Miyares, D.D.S., testified that a score of 4 is given on Procedure 3 when, in the judgment of the examiner, there are only minor errors present which will not jeopardize the procedure; that a score of 3 is given on Procedure 03 when, in the judgment of the examiner, the procedure is completed at entry level; and that a score of 0 on Procedure 03 is mandatory if there is a total lack of contact. The examiners are taught and trained to check for contact when grading a candidate's performance on Procedure 03, as a lack of contact is a very significant error that jeopardizes the integrity of the amalgam restoration. There are two different types of contact involved in a Class II Restoration. The type of contact that was referenced by Examiner 176 in his grade documentation sheet is proximal contact. Proximal contact is when a tooth is restored, the proximal tooth next to it must be touching the tooth that has been prepared. Contact is something that either does or does not exist between two teeth. Contact is checked visually and by running a piece of dental floss between the teeth to see if there is resistance. Examiners 290 and 299 would have been required to give the Petitioner a grade of 0 on Procedure 03 if they had found a lack of contact. The findings of examiners 290 and 299 during their review of the Petitioner's performance on Procedure 03 were inconsistent with the findings of examiner 176 (lack of contact) during his review of the Petitioner's performance on Procedure 03. The inconsistency between the findings of examiners 290 and 299 and the findings of examiner 176 during their review of the Petitioner's performance on Procedure 03 were statistically unusual. Respondent performed Procedure 03 on the patient Desiree Peacock. Following the exam, Peacock used dental floss on the affected area and she believed she felt resistance. Although the grading on Procedure 03 of the clinical portion of the examination is inconsistent, the Respondent followed its standard testing procedures for the December 1997 dental examination. The evidence is insufficient to prove that the Respondent's examiner acted arbitrarily or capriciously or with an abuse of discretion in refusing to give the Petitioner a passing grade on procedure 03 of the clinical examination.
Recommendation Upon the foregoing findings of fact and conclusions of law, it is RECOMMENDED that the Board of Dentistry enter a Final Order dismissing the Petitioner's challenge to the grade assigned her for the clinical portion of the December 1997 dental licensure examination. DONE AND ENTERED this 22nd day of September, 1998, at Tallahassee, Leon County, Florida. DANIEL M. KILBRIDE Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 22nd day of September, 1998. COPIES FURNISHED: Anne Williamson, Esquire Department of Health Building 6, Room 102 1317 Winewood Boulevard Tallahassee, Florida 32399 Dr. Neda Raeisian 2161 Lake Debra Drive Apartment 1726 Orlando, Florida 32835 Pete Peterson, General Counsel Department of Health 2020 Capital Circle, Southeast Bin A 02 Tallahassee, Florida 32399-1703 Angela T. Hall, Agency Clerk Department of Health 2020 Capital Circle Southeast Bin A-02 Tallahassee, Florida 32399-1703
The Issue Whether respondent's license to practice dentistry should be revoked or otherwise disciplined on grounds: (1) that he incompetently performed root canal surgery, and (2) that he accepted and performed professional responsibilities which he knew or should have known he was not competent to perform.
Findings Of Fact Respondent has been licensed to practice dentistry in Florida since January, 1977. At all times material to this proceeding, he practiced dentistry at his office located at 6221 Margate Boulevard, Margate, Florida. (Testimony of Sabroske; P-2, P-7.) II. On June 4, 1980, respondent performed root canal surgery on the lower left second molar (tooth No. 18) of his patient, Leon Seaver. (Testimony of Sabroske; P-1.) Root canal surgery is an endodontic procedure for removal of the diseased nerve or pulp of a tooth. Access to the pulp chamber is obtained by drilling a hole through the tooth's surface. The pulp chamber is then inspected and the root canals are located. The pulpal or nerve tissue is manually removed from the canals by twisting small files of increasing size. The nerve pulp has been removed when tooth filings are detected and the dentist feels increased resistance to the twisting of the file; moreover, an x-ray is taken which shows that the file has reached the apex of the root and completely filled the canal. The hollowed canals are then sterilized by medication and filled with gutta percha or silver point. Then the chamber access or opening is restored. (Testimony of Dixon.) In performing root canal surgery on Leon Seaver, respondent drilled too deeply into the tooth and perforated the floor of the pulp chamber between the two roots of tooth No. 18. He also failed to remove the pulpal tissue from the canal of the mesial root; diseased tissue thus remained in the mesial root canal. (Testimony of Dixon, Sabroske; P-4, P-6.) Seaver, complaining of continuous pain from the tooth, returned to respondent's office on June 16, 1980. Respondent took x-rays but failed to detect the perforation of the tooth floor and pulpal tissue remaining in the mesial canal. He then permanently filled the tooth with gutta percha point-- which filled the intraradicular area between the two roots instead of the mesial root canal, where the diseased pulpal tissue remained. (Testimony of Seaver, Dixon; P-1.) Seaver continued to experience pain and, eventually, the tooth had to be extracted. (Testimony of Seaver.) III. Respondent's performation of the tooth's pulpal floor, his failure to remove the pulpal tissue from the canal in the mesial root on June 4, 1980, and his failure to detect and correct the incomplete removal of the pulpal tissue on June 16, 1980, deviates from minimum dentistry standards of diagnosis and treatment which generally prevail among his professional peers. (Testimony of Dixon, Sabroske.) IV. Respondent graduated from dental school at Ohio State University in 1965. He was dismissed from dental school at the end of the spring quarter of 1963 because he had not met the clinical requirements for graduation. This was due, in part, to the fact that he was married and working part time while attending dental school. In the autumn quarter of 1964, he returned to school and successfully completed the courses required for graduation. (Testimony of Sabroske; P-7.) Although respondent is not a specialist in endodontics, he performs endodontic procedures. Endodontics is considered a part of the practice of general dentistry; dentists are trained to perform ordinary endodontic procedures. Endodontics is not a significant portion of respondent's practice. (Testimony of Dixon, Sabroske.) In the autumn quarter of 1962, respondent failed a course in endodontics at Ohio State University dental school. There was no evidence that he failed any of the seven other endodontics courses he took at dental school; he earned an A and B in two of those courses. (P-7.) Because of the difficulties he encountered in the endodontics procedure which he performed on Leon Seaver, respondent--on his own initiative-- took a continuing education course on endodontics offered by the University of Florida College of Dentistry in November, 1980. (Testimony of Sabroske; R-1.)
Recommendation Based on the foregoing, it is RECOMMENDED: That respondent's license to practice medicine be suspended for one (1) month; That he be required to pay an administrative fine of $1,000; and That (following the one-month suspension) respondent be placed on probation for one (1) year, subject to the condition that, during that time, he successfully complete twenty-five (25) hours of recognized continuing education courses in endodontics. (For purposes of satisfying this condition, respondent should be given credit for the continuing education course he completed at the University of Florida on November 1, 1980.) DONE AND RECOMMENDED this 16th day of April, 1982, in Tallahassee, Florida. R. L. CALEEN, JR. Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 16th day of April, 1982. COPIES FURNISHED: Richard Sabroske, D.D.S. 6221 Margate Boulevard Margate, Florida 33063 Theodore R. Gay, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Fred Varn, Executive Director Board of Dentistry 130 North Monroe Street Tallahassee, Florida 32301 Samuel R. Shorstein, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
Findings Of Fact Dade Dental Laboratories was opened in 1973-74 by a nonprofit corporation which leased dental facilities contiguous and internally connected thereto to dentists. One of the original organizers of the laboratory, Samuel Kushner, was a laboratory technician who had so worked in New York for many years. Respondent was employed on a salary (hourly) basis in 1978 to work as a dentist at the dental facility located at 1225 Washington Avenue, Miami Beach, Florida and known as Dade Dental Associates (hereinafter referred to as Dade Dental). At this time, Dade Dental Laboratories was owned by the wives of Samuel Kushner and Frank Schiller. Schiller was employed as office administrator. Dade Dental Laboratories owned the lease of the premises and equipment located therein. In 1978, the dental office spaces were leased to Frederick Stang, D.D.S., who employed Respondent and other dentists on a salary basis. Effective 1 July 1979, Respondent's wife purchased the fifty percent interest in the laboratory previously owned by Mrs. Kushner and the sub1ease of the dental offices was given to Respondent. Stang continued as an employee of Respondent until September 1979. Frank Schiller spoke Yiddish and was often used as a translator for some of the older Jewish clients who came to Dade Dental. After the sublease was given to Respondent, Schiller continued as administrator until September 1979. The ownership of the fifty percent interest in the laboratory owned by Mrs. Schiller, if not still held by Mrs. Schiller, was not shown. Inspections of the premises at 1225 Washington Avenue were conducted in August, September and October 1979 and again in January 1980. The inspection conducted by the Department of Health and Rehabilitative Services on September 24, 1979 revealed X-ray equipment that was defective by reason of not being properly shielded and having a timer operating erratically (Exhibits 4 and 5); the inspections conducted September 6 and 13 revealed old equipment, improper sterilization of instruments, a very dirty laboratory, dirty impression trays, bite blocks with teeth marks indicating prior use, rusted instruments where chrome had chipped off the underlying steel, no sterile sutures, and a cold dry-heat sterilizer. Following these inspections, Respondent ordered a new X-ray machine and new instruments. No evidence was presented that the rusty instruments found in the dental operatories were ever used on a patient. Respondent's testimony, which was not rebutted, was that he didn't like the instruments located in the operatories when he started working there and he brought his own instruments which he used. The charges of allowing unauthorized persons to perform acts constituting the practice of dentistry, malpractice, misconduct in business or personal affairs of a nature to bring the dental profession into disrepute, and failing to exercise proper care in the treatment of patients involved Joseph Cedar and Hilda Hirschman. After receiving a high estimate of the cost for needed dental work from his dentist, Joseph Cedar, at the recommendation of a friend, went to Dade Dental for a second estimate. He first saw Frank Schiller, who took Cedar to Seymour Rickles, D.D.S., one of the dentists employed at the facility. Cedar described Schiller as the "boss" who gave orders and who looked into his mouth. No evidence was presented that Schiller ever put his hands or any instrument in Cedar's mouth while Cedar was being treated by Respondent or any other dentist at Dade Dental. After examination and impression, Rickles prepared crowns and a partial denture. Although Cedar testified that Rickles performed all the work done on him, the dental record (Exhibit 14) shows 5 dentists worked on Cedar at this office. However, most of the work appears to have been done by Rickles and Stang. After the work on Cedar had been completed, he complained of pain from the partial dentures which had been prepared for him and was referred to Respondent, who first saw Cedar on June 28, 1979 when he adjusted the partial plates. Exhibit 14 indicates Respondent again saw Cedar on July 3, 19, 24, 25 and August 7 for adjustments. Cedar testified he told Respondent about a sore spot near the partial denture on the upper left side of his mouth but Respondent only told him it was not caused by the dentures. Respondent's version was that he X-rayed the lower right side of Cedars' mouth where the partial had been fitted and found an abscess which could cause the pain described by Cedar, and that Cedar never complained of soreness in the upper left area of his mouth. On August 15 or 16, 1979 Cedar went to the dental clinic at Mount Sinai Medical Center complaining of a soreness in the upper left area of his mouth. He was examined by several dentists because the affected area looked suspicious, and a biopsy was done. This showed the lesion to be squalus cell carcinoma, which was subsequently excised. The lesion removed from Cedar's mouth was well-differentiated in mid- August when he was seen at Mt. Sinai. It is unlikely that a well-differentiated lesion will develop in a week to ten days, but could develop in a period of two or more weeks. A competent dentist should recognize a well-differentiated lesion and refer the patient to an oral surgeon. Failure to do so constitutes practice below minimum accepted community standards. Respondent has referred other patients to oral surgeons when suspicious conditions were observed in patients' mouths. (Exhibit 18). Hilda Hirschman first visited Dade Dental in December 1978 and was referred to Respondent. She had several teeth extracted by Respondent, partial dentures made and two crowns installed. Mrs. Hirschman testified that Schiller escorted her into Respondent's office on her first visit and wrote down and quoted to her prices for work as he and Grebin talked. She thought Schiller was the head dentist. She also testified that one time Schiller ground down one of her teeth. When told periodontal treatment was indicated, Mrs. Hirschman told Respondent she did not want root canals done. After her teeth had been extracted and partials made, the partials were inserted by Respondent, but neither of the partials fit. The upper was adjusted to fit and a second impression was taken for the lower. Mrs. Hirschman was later examined by Dr. Leonard Sakris at the request of the Dental Board. From his study of the X-rays taken in November 1978 and August 1979 and his examination of the patient, Dr. Sakris opined that the teeth extracted by Respondent could have been saved if root canal therapy had been used and crowns installed. This examination also revealed the condition of Mrs. Hirschman's mouth to be bad, with two ill-fitting partial dentures and restoration placed over decay. The conclusion this decay existed when Respondent treated Mrs. Hirschman was reached from the X-rays. On cross- examination, Dr. Sakris acknowledged that decay was not always discernible on X- rays and could be misdiagnosed absent a visual examination and probe by the dentist. Dr. Sakris' examination did not confirm Mrs. Hirschman's testimony that Schiller had ground down her tooth. He found no evidence of grinding, except possibly on Lower Left Canine 3. This is also the tooth with decay found on Sakris' examination. The crown on Lower Right 5 placed by Respondent had a bad margin and decay when Mrs. Hirschman was examined by Sakris. Unless margin of crown makes solid contact with tooth, decay can occur. It is below acceptable minimum standards to leave open margins between crown and tooth. Respondent's testimony that he suggested Mrs. Hirschman go to a periodontist for root canal treatment and she refused is corroborated by Mrs. Hirschman's testimony that she didn't want the expense of root canals. Without periodontal treatment for Mrs. Hirschman's dental condition, extraction is the standard practice. Respondent's testimony that both he and Stang worked on Mrs. Hirschman is supported by Exhibit 13 and lends credence to his testimony that he did not prepare the crowns he installed on this patient. Further, Exhibit 13 contains the notation that Mrs. Hirschman "refuses pero" (presumably periodontal treatment) and confirms Respondent's testimony that the patient's refusal to have root canals left him no choice but extraction. The parties stipulated that the advertising which forms the basis for Counts XVI II through XXI was ordered and paid for by Stang, although it continued for some two months after Respondent took over the operation of the dental clinic before it was stopped. Respondent's testimony that he neither ordered nor paid for the advertising which appeared after July 1, 1979 was not disputed. No evidence was presented regarding the character of this advertising, other than the examples thereof shown in Exhibit 8.
Findings Of Fact William Cecil Graham is licensed by the Florida State Board of Dentistry and at all times herein involved was so licensed. Dr. Graham began treating Mrs. Dover Stokes in August 1977, and during the time Mrs. Stokes was a patient, Respondent performed oral surgery, extractions and prepared upper and lower partial plates. All this work was done in Respondent's office located at 16580 Northwest 10th Avenue, Miami. For this work Mrs. Stokes paid Respondent approximately $500. Mrs. Stokes suffers from glaucoma and is nearly blind. She began going to Respondent for treatment upon the recommendation of one of Mrs. Stokes' roomers who is a cousin of Respondent. This roomer generally provided Mrs. Stokes transportation to and from Respondent's office for treatment. After the impressions for the plates had been taken and close to the time these plates were delivered to Respondent, he suddenly had to leave the Northwest Miami office. He advised Mrs. Stokes, and presumably his other patients, of his imminent departure and that he would contact her when relocated. Since he had by then received the partial dentures, Mrs. Stokes asked him to bring them to her. Respondent had been to Mrs. Stokes home on previous occasions to collect payments and he agreed to bring the plates to her. When Respondent took these plates to Mrs. Stokes, he brought along a portable hand grinder to adjust the plates. During this visit, Respondent tried the plates in Mrs. Stokes' mouth and she found them tight. After making some adjustments, Respondent left with the plates for additional adjustment. No instrument was used in Mrs. Stokes' mouth while the plates were being fitted at her home. Respondent returned to Mrs. Stokes' home in early November 1977, inserted the plates and made additional adjustments. Mrs. Stokes was happy with the plates at this time. Upon leaving, Respondent advised Mrs. Stokes that he would contact her as soon as he was relocated in an office. After not hearing from Respondent and experiencing discomfort with her plates, Mrs. Stokes began searching for Respondent. Mrs. Stokes testified that she called Graham's home and his wife couldn't tell her how to contact Graham. Respondent testified that Mrs. Stokes called his home, spoke to his wife who relayed Mrs. Stokes message to him, and that he called Mrs. Stokes in early January 1978. At this time, Graham was still without an office. During this conversation, Mrs. Stokes expressed her dissatisfaction with Respondent. When he offered to send her to another dentist, Mrs. Stokes said she didn't want another black dentist. At this point Respondent realized further communication with Mrs. Stokes was impossible and he suggested that she select a dentist and he, Graham, would pay for the treatment she needed. Mrs. Stokes doesn't recall this conversation; however, Respondent's testimony in this regard is accepted as the true version of what happened. Mrs. Stokes next contacted the State Dental Board with her complaint about Respondent. The matter was referred to a Board member in Miami, Marshall A. Brothers, who telephoned the number of the office in Northwest Miami where Stokes had previously worked and was advised the whereabouts of Graham was unknown. Dr. Brothers did not speak directly to one of the dentists in the Northwest Miami office when the call was made to locate Graham. No correspondence was sent to the office previously used by Respondent. When Brothers was unable to contact Graham, he did nothing further to investigate the treatment that had been provided Mrs. Stokes by Respondent. In July 1978, Respondent opened an office on Northwest 54th Street in Miami. Mrs. Stokes telephoned the office and Respondent returned her call. He offered to examine her teeth, but Mrs. Stokes said she didn't want him to work on her. Respondent then renewed his offer to Mrs. Stokes to select a dentist of her choice, have him do the necessary work, and he, Graham, would pay for it. Mrs. Stokes then visited a dentist close to her home and advised him that Respondent would pay for the treatment. This dentist, Dr. Efrom, called Respondent who confirmed that he would pay for the treatment Mrs. Stokes required. Dr. Efrom found some rough places on the plates which he polished, corrected some sore spots in Mrs. Stokes' mouth, filled a cavity, and his technician cleaned Mrs. Stokes' teeth. Respondent paid for this treatment, although he had not contracted to fill a tooth for Mrs. Stokes or to do the cleaning.
Findings Of Fact The Respondent, Peter Kurachek, was a licensed dentist at all times relevant to the allegations contained in the Administrative Complaint, having been issued license number 0005429, and was so licensed at the time of hearing. On January 19, 1981, Clarence Nicholson consulted the Respondent at the Sheppard Dental Center in Clearwater, Florida, regarding a dental problem. The Respondent performed a root canal treatment on Nicholson's tooth number six, a cuspid, and prepared the tooth to receive a crown. On January 31, 1981, the Respondent installed the permanent crown, which he had had prepared. In August 1981, the crown fell out, and Nicholson returned to the Sheppard Dental Center. Nicholson did not see the Respondent on this visit, and the crown was recemented by Dr. Christopher Clarke. In November 1981, the crown fell out a second time. Nicholson returned to the Sheppard Dental Center. On this occasion, Nicholson did not see Respondent, and the crown was recemented in place by Dr. Clarke. Dr. Clarke made no gross alterations to the crown on either of the appointments; however, he did clean the crown in preparation for recementing it on both occasions. Shortly after Dr. Clarke recemented the crown the second time, Nicholson saw Respondent and requested that he correct the crown. The Respondent advised Nicholson that he would be happy to replace the crown and redo the work if the crown became loose again. Respondent feared that forcefully removing the crown in order to prepare a new one might damage Nicholson's tooth. Because he would be responsible if the tooth were broken while removing the crown, the Respondent elected to deal with Nicholson's problem if the crown became loose again of its own accord. In April 1982, more than a year after Respondent did the work for Nicholson, and after the crown had been recemented twice by another dentist, Nicholson was examined by Dr. Paul Hounchell, a dental consultant for the Petitioner. As a result of his examination, Dr. Hounchell opined that the treatment provided by the Respondent did not meet the minimal accepted standards of practice in the community. (Tr. 81.) However, Dr. Hounchell indicated that his opinion was based upon the fact that Nicholson was unable to have the crown fixed to his satisfaction. Dr. Hounchell stated, "The only unprofessional thing is that we run this man around, you know, for a half a year, a year or something like that." (Tr. 121.) The record reflects that Nicholson only saw the Respondent one time after the Respondent installed the crown, and that on that occasion the Respondent told Nicholson that he would replace the crown to Nicholson's satisfaction if the crown became loose again. The record further reflects that Nicholson never tried to see the Respondent thereafter. The tooth in question was a nonvital tooth as a result of the root canal therapy. Such a tooth is more brittle and may fracture more easily. However, the tooth had a good-sized large root which was adequate to support a longer post. The various dentists disagree concerning whether it would have been appropriate for the Respondent to have removed the crown when he saw Nicholson after Dr. Clarke had recemented the crown in place. The treatment provided by the Respondent to Nicholson met minimum acceptable standards of practice in the community.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is recommended that the charges against the Respondent, Peter Kurachek, D.D.S., be dismissed. DONE and RECOMMENDED this 25th day of April, 1983, in Tallahassee, Leon County, Florida. STEPHEN F. DEAN, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 25th day of April, 1983. COPIES FURNISHED: Julie Gallagher, Esquire Department of professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Peter Kurachek, DDS 703 Tropical Circle Sarasota, Florida 33581 Frederick Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 H. Fred Varn, Executive Director Board of Dentistry 130 North Monroe Street Tallahassee, Florida 32301
The Issue The issue is the appropriate penalty to be imposed upon Dr. Carroll for two admitted violations of the Dental Practice Act: (1) performing root canal treatment which was below acceptable standards, and (2) practicing beyond the scope of dentistry.
Findings Of Fact Findings Concerning Liability The following findings of fact are based upon the paragraphs or subparagraphs of the Administrative Complaint which Dr. Carroll admits: Inadequate Root Canal Therapy Dr. Carroll treated Sylvia Lankheim. He performed root canal therapy on Ms. Lankheim's lower left second bicuspid (tooth #20) and provided a post and crown for the tooth. Dr. Carroll's endodontic treatment and post and crown restoration of tooth #20 were inadequate, and subsequently failed. Practicing Beyond the Scope of Dentistry Dr. Carroll neither admits nor denies the following allegations found in the Administrative Complaint, but agrees that they make out a prima facie case for the charge of practicing beyond the scope of dentistry: On or about October 31, 1983, Dr. Carroll made a presentation at a local condominium association concerning the purported hazards of mercury poisoning resulting from amalgam restorations in teeth. His presentation included films, testimonies by two former patients, and paraphernalia used to test for mercury toxicity. As the result of this presentation, Ms. Sylvia Lankheim scheduled an appointment with him on about November 3, 1983. When Dr. Carroll saw Ms. Lankheim on November 3, he took full mouth x-rays and made an impression of her teeth for study models. On or about November 8, 1983, Dr. Carroll's dental assistant conducted a Mercury Patch Test on Ms. Lankheim to determine her sensitivity to mercury. The test involves placing a solution of mercury chloride on a band- aid, placing the band-aid on the forearm, removing the band-aid 24 hours later and interpreting the patient's dermatological response to the test. Use of a patch test to determine an allergic response or sensitivity to mercury is not within the scope of the practice of dentistry as defined in Section 466.003, Florida Statutes (1985). The patch test used by Dr. Carroll to determine an allergic response or sensitivity to mercury is not reliable and its use is unproven. Based upon these facts, Dr. Carroll has agreed he is guilty of the charge of practicing beyond the scope of dentistry, in violation of Section 466.028(1)(z), Florida Statutes (1985), as alleged in paragraph 13(d) of the Administrative Complaint. Findings Pertaining to Penalty Penalty guidelines have been adopted by the Board of Dentistry in Rule 21G-13.005, Florida Administrative Code. The penalty for incompetence in the practice of dentistry is prescribed under Rule 21G-13.005(2)(bb) as follows: Being guilty of incompetence. The usual action of the Board shall be to impose a period of probation, restriction of practice, suspension and/or revocation. The usual penalty for practicing beyond the scope of dentistry is stated in Rule 21G-13.005(2)(dd) as follows: Practicing or offering to practice beyond the scope permitted by law or accepting and performing professional responsibilities which the licensee knows or has reason to know that he is not competent to perform. The usual action of the Board is to impose a period of probation, restriction of practice, and/or suspension. The Board may deviate from these penalties in an individual case based upon the following aggravating or mitigating factors: The severity of the offense; The danger to the public; The number of repetitions of offenses or number of patients involved; The length of time since the violation; The number of times the licensee has been previously disciplined by the Board; The length of time the licensee has practiced; The actual damage, physical or otherwise, caused by the violation and the reversibility of the damage; The deterrent effect of the penalty imposed; The effect of the penalty upon the licensee's livelihood; Any efforts of rehabilitation by the licensee; The actual knowledge of the licensee pertaining to the violation; Attempts by the licensee to correct or stop the violation or refusal by the licensee to correct or stop violation; Related violations against the licensee in another state including findings of guilt or innocence, penalties imposed and penalties served; Penalties imposed for related offenses... Rule 21G-13.005(4)(a)-(n), Florida Administrative Code. Dr. Carroll relies on a number of recent cases decided by the Board of Dentistry to argue that the appropriate penalty in this case is a fine of no more than $1,000, and a requirement that he attend 20 to 25 hours of additional training in endodontics in addition to the continuing education required of dentists to maintain their licensure. He maintains that no probation is necessary, as rehabilitation or as punishment. In the case of Board of Dentistry v. Norman A. Fenichel, reported at 10 FALR 6745 (Board of Dentistry, 1988) the Board imposed an administrative fine of $1,500 and placed the dentist on probation for two years, with a requirement that he attend 36 hours of continuing education in crown and bridge work, 36 hours in endodontics and 12 hours in the laws and rules relating to the practice of dentistry or ethics. The penalty was based upon findings made after a formal hearing that the dentist had performed inadequate root canal therapy, and that after the patient had stopped payment on the check for that dental work due to pain and the improper seating of the crown. Fenichel had failed to forward her file to a subsequent treating dentist. Dr. Carroll also relies on other discipline cases of the Board of Dentistry to support the penalty he advocates, where there were stipulated dispositions in somewhat similar circumstances. The case of Board of Dentistry v. Daniel B. Baldridge, DPR Case 0066648 (Board of Dentistry 1987) involved a charge of a feeble attempt to perform endodontic therapy on tooth #3. The stipulated disposition was a fine of $1,000, a reprimand, and probation far one year during which Dr. Baldridge was required to complete 20 hours of continuing education in endodontics. No portion of the Baldridge stipulation included an agreement that Baldridge was guilty of any violation, which is a significant difference from the present case. In the case of Board of Dentistry v. Vance Bishop, Case 0068343 (Board of Dentistry 1988), Dr. Bishop neither admitted nor denied the allegations of an Administrative Complaint which charged that he had provided incomplete endodontic filling of a tooth on which he placed a crown and that two other crowns were poorly done. A fine of $1,500 was imposed, Dr. Bishop was reprimanded, placed on probation for a year and required to complete 15 hours of continuing education in endodontics and another 15 hours in the area of crown and bridge work, endodontics and another 15 hours in the area of crown and bridge work. In the case of Board of Dentistry v. David Murrin, Board of Dentistry Case 0066593 (Board of Dentistry 1988), Dr. Murrin entered into a stipulation without admitting any of the facts in the Administrative Complaint. According toe the complaint, Murrin had performed a root canal and installed a crown on a mandibular left first molar (tooth #19), but subsequent examination showed that the root canal procedure had never been concluded because there was only partial removal of pulp tissue from the tooth, and no filling material had been used. His records failed to show any therapy had been attempted. Murrin was charged with making untrue representations in the practice of dentistry in violation of 466.028(1)(l), Florida Statutes; malpractice, in violation of 466.028(1)(y), Florida Statutes; exploiting a patient for financial gain in violation of 466.028(1)(m), Florida Statutes; and fraud and deceit in the practice of dentistry, in violation of Section 466.028(1)(u), Florida Statutes. According to the stipulation he paid administrative costs of $1,000, and received a reprimand but no period of probation. In the case of Board of Dentistry v. Frederick Newton, Board of Dentistry Case 0070984 (Board of Dentistry 1988), Dr. Newton entered into a settlement stipulation in which he admitted the allegations of fact contained in the Administrative Complaint (with a small correction of those facts). According to the admitted facts, Dr. Newton provided root canal therapy on tooth #3 and amalgam restorations on teeth #3, 14, 19 and 30. The root canal therapy on tooth #3 was inadequately filled and sealed, Johnson did not record on the patient's chart the use of a rubber dam, did not record the canal length of tooth #3, chart the measurements for the endodontic files he used, or take a post-operative x-ray showing the completed root canal therapy. He was therefore charged with malpractice in violation of Section 466.028(1)(y), Florida Statutes, and failing to keep records justifying the course of treatment in violation of section 466.028(1)(m), Florida Statutes. The Board's final order imposed an administrative fine of $1,500, reprimanded him and placed him on probation for a period of twelve months, in which time he was required to complete 20 hours of endodontic continuing education and one course in recordkeeping.
Recommendation Based upon the foregoing, it is RECOMMENDED that a Final order be entered by the Board of Dentistry finding Dr. Carroll guilty of violation of Sections 466.028(1)(y), Florida Statutes (1985) and 466.028(1)(z), Florida Statutes (1985), that an administrative fine in the amount of $1,500 be imposed, that he be reprimanded, and that his license be placed on probation for a period of one year, during which he shall complete 25 hours of continuing education in endodontics in addition to any other education required to keep his licensure current. DONE and ORDERED this 9th day of May, 1989, in Tallahassee, Leon County, Florida. WILLIAM R. DORSEY, JR. Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 9th day of May, 1989. COPIES FURNISHED: Nancy M. Snurkowski, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Michael J. Cohen, Esquire 517 Southwest First Avenue Fort Lauderdale, Florida 33301 Salvatore A. Carpino, Esquire One Urban Centre, Suite 750 4830 West Kennedy Boulevard Tampa, Florida 33609 Kenneth E. Easley, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 William Buckhalt, Executive Director Board of Dentistry 130 North Monroe Street Tallahassee, Florida 32399 =================================================================
