The Issue This is a license discipline case in which the Petitioner seeks to take disciplinary action against the Respondent on the grounds that the Respondent has violated several statutory provisions by repairing dentures in a licensed dental lab without having obtained the required work order from a licensed dentist.
Findings Of Fact Based on the stipulations of the parties, on the exhibits received in evidence, and on the testimony of the witnesses at hearing, the following facts are found: At all times relevant and material to this case, the Respondent, Magnolia Iole, held license number DL 0002153 issued by the Department of Professional Regulation, which licensed her to operate as a dental laboratory in the State of Florida. At all times relevant and material to this case, the Respondent's dental laboratory was operated at 201 East Oakland Park Boulevard, Fort Lauderdale, Florida, under the business name of All Emergency Denture Service. On April 11, 1990, an investigator with the Department of Professional Regulation took a broken denture to the Respondent's dental laboratory and asked to have it repaired. The broken denture was a woman's denture that had been obtained by one of the other Department investigators from a local dentist's office. The investigator who presented the broken denture for repair had not seen any dentist regarding the broken denture, nor did the investigator have any work order from a dentist for the repair. On April 11, 1990, an employee of the Respondent's dental laboratory agreed to repair the broken denture that was brought in by the Department investigator. The employee said that the repair would cost $50.00, and that the denture would be ready later than same day. Later that same day two Department investigators returned to the Respondent's dental laboratory, where they met the same employee who had agreed to repair the broken denture. The employee told the investigator who had brought the denture that it would be ready in a few minutes. A few minutes later the employee of Respondent's dental laboratory handed the repaired denture to the investigator who had brought it in earlier the same day. At that time the previously broken denture was completely repaired. Although the Respondent, Magnolia Iole, was not observed on the dental laboratory premises during the events of April 11, 1990, described above, she was aware that such events were taking place, because during a telephone conversation on April 12, 1990, Magnolia Iole admitted to a Department investigator that she had been taking repair work without work orders because she needed the money. A work order for denture repair is an order from a licensed dentist to a dental laboratory directing that certain repair services be performed. The work order is, essentially, a prescription for the performance of specific services. A dental laboratory is not permitted to perform a repair of an intra- oral dental appliance without a work order signed by a licensed dentist. A dental laboratory that repairs a denture without a work order issued by a licensed dentist is engaged in the unauthorized practice of dentistry. Denture repair under such circumstances also constitutes the acceptance and performance of professional responsibilities which the dental laboratory licensee is not competent to perform. Denture repair without a work order issued by a licensed dentist, even when the repairs are excellently accomplished, can prevent the discovery of emerging dental problems and cause them to go untreated to the harm of the patient.
Recommendation For all of the foregoing reasons, it is recommended that the Board of Dentistry enter a final order in this case concluding that the Respondent has violated Sections 466.028(1)(z) and 466.028(1)(bb), Florida Statutes, and imposing an administrative penalty consisting of a six month suspension of the Respondent's license, to be followed by a one year period of probation during which the Respondent shall be required to advise the Board quarterly of all work performed by the Respondent's dental laboratory and shall comply with all statutory and rule provisions governing the activities of dental laboratories. DONE AND ENTERED at Tallahassee, Leon Coun~y, Florida, this 21st day of May, 1991. MICHAEL M. PARRISH 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 21st day of May, 1991. COPIES FURNISHED: Albert Peacock, Esquire Department of Professional Regulation Northwood Centre 1940 North Monroe Street Tallahassee, FL 32399-0792 Ms. Magnolia T. Iole 531 Northwest 39th Street Oakland Park, Florida 33309 Mr. William Buckhalt, Executive Director Florida Board of Dentistry Department of Professional Regulation 1940 North Monroe Street Suite 60 Tallahassee, FL 32399-0792 Jack McRay, Esquire General Counsel Department of Professional Regulation 1940 North Monroe Street Suite 60 Tallahassee, FL 32399-0792
The Issue At issue in this case are: (1) the Petitioner's standing; (2) the validity of the Respondent's proposed amendment to F.A.C. Rule 21G-8.004(2) (the so- called designation rule), which would designate the Alabama Dental Hygiene Program (ADHP) as a dental hygiene college or school under Section 466.007, Fla. Stat. (1989); and (3) the validity of the Respondent's proposed amendment to Rule 21G-8.004(3) (the so-called criteria rule), which would establish criteria for approval of a dental hygiene college or school under Section 466.007, Fla. Stat. (1989).
Findings Of Fact The Petitioner, the Florida Dental Hygienist Association, Inc., is a state association whose members are dental hygienists licensed to practice dental hygiene under Chapter 466, Fla. Stat. (1989). The Petitioner contends that the effect of the designation rule will be to allow inadequately educated dental hygienists to sit for examination for licensure in Florida with a resultant dilution of the quality of licensed dental hygienists available to practice dental hygiene in Florida. It is the purpose of the Florida Dental Hygienists Association to insure that the quality of dental hygiene practice is maintained and to insure that the persons licensed as dental hygienists in this state meet minimum education and training requirements. The Challenged Rules The proposed rule under challenge in Case No. 89 designation rule) would amend F.A.C. Rule 21G-8.004(2) by adding the language: The Alabama Dental Hygiene Program sponsored by the Alabama Board of Dental Examiners is determined to be a dental hygiene college or school within the meaning of Section 466.007, F.S., and is hereby approved by the Board. The proposed rule under challenge in Case No. 90 criteria rule) would renumber what is now (3) of F.A.C. Rule 21G-8.004 as (4) and would insert as (3) the new language: Colleges or schools whose program meets the following criteria shall be approved by the Board for the purposes of Section 466.007(2)(b), F.S., upon submission of evidence which establishes compliance with the following requirements: The educational program provides at least 50 hours of formal preclinical training and one year of clinical training which shall include performance of a minimum of 75 prophylaxes. The educational program provides instruction in the following subject areas as they relate to dental hygiene practice. The program shall consist of at least 260 total hours, at least 160 hours of which shall be provided through formal classroom instruction. Students shall be required to successfully complete examinations testing the subject matter presented through formal classroom instruction. Anatomy; Physiology; Biochemistry; General Chemistry; Microbiology; Pathology; Nutrition; Pharmacology; Pain Control; Tooth Morphology; Head, Neck and Oral Anatomy; Oral Embryoloty and Histology; Oral Pathology; Dental Materials; Periodontology; Radiography; Clinical Dental Hygiene (clinical and didactic instruction); Oral Health Education; Community Dental Health; Patient Management; and Medical and Dental Emergencies (including basic life support). Accredited Programs Dental hygiene in Florida is taught in the community college system. There are nine community colleges that have dental hygiene programs, all of which are accredited by the Commission on Dental Accreditation of the American Dental Association. Course work requirements for a dental hygiene degree range from 70 to 95 academic credit hours over a two year plus time period. Florida dental hygiene programs require in excess of 70 credit hours (60 credits being the minimum that a student can have in order to receive an associate of arts degree). Typical of the dental hygiene programs are the dental hygiene programs at the Valencia Community College and the Pensacola Junior College Dental Hygiene Program, each of which requires a minimum of 84 credit hours for a degree. The program includes general education and science courses as well as dental hygiene courses. The curriculum is comprehensive and includes general education, basic sciences, and didactic and clinical dental hygiene education. Education by Florida community colleges is offered at a minimum competency level reflected in standardized "curriculum frameworks" for each program. The frameworks establish a standardized guide for development of education programs and are required by state and federal law. The curriculum frameworks are adopted by the State Board of Education. The curriculum framework for dental hygiene education makes clear that it is to meet the standards for accreditation by the Commission on Dental Accreditation of the American Dental Association. The dental hygiene curriculum frameworks are built on national standards to achieve "leveling," reasonable standardization of education allowing educational credit to be transferred from one school to another. The Accreditation Standards for Dental Hygiene Educational Programs and the Procedures for Evaluation of Dental Hygiene Programs show that dental hygiene education at programs accredited by the Commission on Dental Accreditation is comprehensive. The Commission on Dental Accreditation requires both didactic and clinical dental hygiene education to: (1) be offered at the college level in post-secondary schools or colleges accredited by a regional accrediting agency recognized by the Counsel on Post-Secondary Accreditation; (2) award an associate or baccalaureate degree; and (3) prepare students to continue their education. Regional accrediting agencies require general and liberal arts education as part of the basic studies for each student. A basic science background in dental hygiene education helps students understand the transmission of diseases, such as AIDS. Liberal arts education helps prepare the dental hygienist for effective patient communication relating to dental hygiene. Neither the curriculum frameworks nor the Commission's accreditation standards for dental hygiene education programs establish the number of hours of formal education for each of the components of the curriculum. Some of these components include the maintenance of patient financial records, the collection of fees, the maintenance of dental office inventory controls, the demonstration of public relations responsibilities, the demonstration of skills on office equipment, and the demonstration of employability skills including job interviews and appropriate job changes. Florida's community college programs must also be accredited by the Southern Association of Colleges and Schools. This accrediting body requires all vocational programs at the associate level to offer a minimum of 25% of credit hours in general education and liberal arts which can include subjects such as sociology, government, humanities, art history, music appreciation, etc. In some of Florida's programs, liberal arts and general education may comprise as much as 50% of the dental hygiene curriculum. The dental hygiene curriculum requirements in Florida's community colleges go beyond the Commission on Dental Education minimum requirements in terms of the core dental hygiene instruction. In post-secondary academia, the term "college" means an established institution of higher learning; the term "school" means an organized body that leads to a post-secondary degree. A school is usually organized within a college. A "program" is a term of art in academia that means an identified, organized course of study leading to a degree. Programs are offered within academic schools or colleges. In practice, in dental hygiene academia, the terms "dental hygiene college," "dental hygiene school" and "dental hygiene program" are synonymous. The Commission on Dental Accreditation has accredited Florida's nine dental hygiene programs as opposed to the schools in which they reside. The Commission on Dental Accreditation of the American Dental Association accredits those organized courses of study that lead to a degree in dental hygiene, regardless of whether the course of study is labeled a "dental hygiene college," "dental hygiene school" or "dental hygiene program." The Alabama Dental Hygiene Program The Alabama Dental Hygiene Program (ADHP) is not accredited by, nor does it have status toward accreditation by, the Commission on Dental Accreditation of the American Dental Association. The Alabama Dental Hygiene Program began in 1959 as a system of non- academic preceptorship training. Under the ADHP, any licensed dentist is approved by the state licensing board to provide on-the-job training in dental hygiene to dental assistants with at least one year experience as a dental assistant. 1/ (Candidates also must be at least 18 years of age and must be a high school graduate.) The sponsoring dentist is responsible for the clinical adequacy and thoroughness of training. The program is administered by the Alabama Board of Dental Examiners, which has final authority over it, in concert with the Alabama Dental Association. A candidate cannot enter the program without sponsorship by a dentist. The Alabama Dental Hygiene Program now is a one year course of study that combines formal classroom education with hands-on clinical training. Participants receive approximately 165 hours of didactic lectures in 2 separate week-long sessions and 4 weekend sessions concurrent with the one year of preceptor training. Accredited programs generally include a minimum of approximately 1,000 classroom hours. Faculty and facilities for didactic lectures are provided by the University of Alabama College of Dentistry in Birmingham, Alabama, on a contractual basis. With the exception of one dental hygienist from North Carolina, all of the faculty members for the current ADHP class are on the UAB dental faculty. But it is not a program within or sponsored by the university, nor does the university give academic credit for it. It does not lead to a post-secondary degree. The Alabama Dental Hygiene Program includes significantly less formal classroom education in all of the areas of general education and basic sciences and significantly fewer lectures in the clinical practice of dental hygiene than do accredited programs. The Alabama Dental Hygiene Program does not include the following courses required in an accredited program: chemistry, head and neck anatomy, histology, periodontology, nutrition, public health, pharmacology, pathology, dental materials, law and ethics, sociology, psychology and English. A course in disease control, which is of particular importance since the onset of AIDS, and which requires a strong basic science and biology background, also is absent from the ADHP. Examples of some of the differences are: ADHP ACCREDITED MODEL LECTURE LAB TOTAL HRS. ANATOMY & PHYSIOLOGY 8 88 66 134 MICROBIOLOGY 8 40 40 80 ORAL PATHOLOGY 8 34 0 34 RADIOLOGY 12.5 27 30 57 PREVENTIVE DENTISTRY 12.5 36 6 42 A person trained in the Alabama Dental Hygiene Program would not receive academic credit at Pensacola Junior College or Valencia Community College for the training because it does not meet minimum standards. Clinical training in the office of the sponsoring dentist is done by means of a series of modules which serve, in effect, as building blocks in imparting dental hygiene skills. Each module identifies a number of specific skills that the student must master and requires the sponsoring dentist to evaluate performance for each such skill. The sponsoring dentist must verify in writing that a module has been completed, and the successful completion of all modules is a prerequisite to graduation from the Program. The use of the modules is an attempt to insure that all ADHP students are learning essentially the same skills over the same general period of time. However, the ADHP clinical training is less standardized than under accredited programs. An ADHP student is likely to see more actual patients over the course of the clinical training than a student in a community college program. ADHP clinical training is administered to a one-to-one basis as opposed to the higher student-to-dentist ratio found in community college programs. A great deal of quality control is inherent in the ADHP clinical training in that the student is learning on the sponsoring dentist's patients and he has a professional duty to make sure that a good job is done. However, the dental hygiene exam is the ultimate quality control device for ADHP in that a student must pass the exam in order to become licensed as a dental hygienist. The clinical portion of the Alabama Dental Hygiene Examination is equivalent to the Florida Dental Hygiene Exam in content and in administration. A person who passes the Alabama exam would be expected to pass the Florida exam and vice versa. A six-year comparison of scores on the Alabama clinical exam achieved by ADHP graduates with the scores of graduates of traditional two- or four-year programs reveal that ADHP graduates do just as well as their college- trained counterparts. This is a strong indication of equivalency in terms of clinical abilities. Data from the Alabama Dental Hygiene Licensing Exam also show that the Alabama Dental Hygiene Program graduates perform as well or better as candidates who take the National Board of Dental Hygiene examination. However, comparison of the two examinations is not valid because the National Board Examination is a "norm referenced test" whereas the Alabama Dental Hygiene Examination and the Florida license examination are "criterion referenced tests." There is no valid comparison of examination scores of graduates from the Alabama Dental Hygiene Program with graduates from accredited programs because the Alabama Dental Hygiene Program "graduates" are not eligible to sit for the National Board exam, the only standardized examination. The Proposed Criteria Proposed Rule 21G-8.004(3) provides that a college or school whose dental hygiene program meets the proposed rule criteria shall be approved by the Board of Dentistry. There are 21 subjects listed in the rule, but it is unclear whether those subjects are to be included in the 160 hours of formal classroom instruction or under another setting. There are no minimum number of hours that are attendant to any of the listed subjects. It is not clear whether the hours referenced are academic or actual clock hours. The rule is silent as to the method by which the clinical training is to be provided. The proposed rule is unclear as to its academic requirements and the hours of instruction required. The proposed rule seems to be approving a preceptor or apprenticeship type of dental hygiene training which is similar in structure to the Alabama Dental Hygiene Program. Comparison of ADHP and Criteria with Accreditation Standards The Board of Dentistry bases the proposed rules on a finding that dental hygienists who are trained by the ADHP, or who would be trained in a similar program meeting the requirements of the proposed criteria rule, would by adequately trained to safely and competently perform dental hygiene in dental practices in Florida. Based on the evidence presented, such a finding would be neither arbitrary nor capricious. But the evidence also shows that the training given in the ADHP, and training that would be given in a similar program meeting the requirements of the proposed criteria rule, is not the equivalent of the training given in accredited programs.
The Issue The issue for determination is whether Petitioner successfully completed the clinical portion of the December 1997 dental hygiene examination.
Findings Of Fact In December 1997, Brandy Kern was a candidate for the dental hygiene examination (Examination). Ms. Kern had completed her dental hygiene studies at the University of Pittsburgh on or about April 29, 1995. She was an excellent student. Prior to making application for the Examination, Ms. Kern had obtained experience in dental hygiene by working as a dental hygienist in at least three dental offices over at least a two-year period in the State of Pennsylvania. Her employers, who were dentists, gave Ms. Kern very positive recommendations. Ms. Kern successfully completed all portions of the Examination, except for the scaling/calculus removal portion of the clinical part of the Examination. As a result, Ms. Kern did not successfully complete the overall Examination. The clinical examination consists of three parts: scaling and calculus removal, polishing, and root planing. The overall score for the clinical examination is determined from all three portions. Scaling and calculus removal counts as 70 per cent of the clinical examination; polishing as 10 percent; and root planing as 20 per cent. Each dental hygiene candidate is graded by three examiners. The clinical portion of Ms. Kern's examination was scored by three examiners. The examiners were 197, 243, and 320. Each examiner is a dental hygienist licensed in the State of Florida and is an experienced dental hygienist. An examiner must be recommended by an existing examiner or by a member of the Board of Dentistry (Board), have no complaints against their license, and be actively practicing. To become an examiner, an application must be completed and submitted to an examination committee of the Board. The committee reviews the application and, if approved, the applicant is placed in a pool of examiners. Before every examination, each examiner is trained in evaluating a procedure to make sure that it is properly performed. The Department of Health (Department) conducts a training in which each examiner is trained to grade using the same internal criteria. Such training results in a standardization of grading criteria. In this training process, the examiners are trained by assistant examiner supervisors on the different criteria that are used during the examination. The assistant examiner supervisors are dentists licensed in the State of Florida and are appointed by the Board of Dentistry (Board). To further their training, after the examiners receive their verbal training, the examiners are shown slides of teeth which do not meet the clinical criteria of the examination. To make sure that the examiners have been able to internalize the criteria, following the standardization, the examiners, themselves, are given an examination. Included in the examination is a hands-on clinical, where mannequins are used and the examiners check for errors on the mannequins. After the examiners complete their examination, the Bureau of Testing evaluates the examiners to determine whether the examiners are acceptable to use for the Examination. Subsequent to the Examination, the examiners are scored by the Bureau of Testing. The scoring is based on an examiner's performance wherein the Bureau of Testing examines how every examiner grades with every other examiner to make sure that the examiners are grading with reliability. This review is based on corroborated errors found by an examiner, not on the average errors found by an examiner. The average errors found by an examiner are irrelevant to the examiner's performance in that one examiner may have graded candidates who made numerous errors, while another examiner may have graded candidates who made very few errors. For the Examination, candidates are required to bring human patients on whom the candidates perform the dental procedures. Each examiner grades the Examination independently. The examiners do not confer with each other while scoring the Examination. Furthermore, the Examination is double-blind graded, which is a grading process in which the candidates have no contact with the examiners. The candidates are located in one clinic and perform the dental procedures on their human patient. The clinic is monitored by a licensed dental hygienist. When the candidate completes the procedures, a proctor accompanies the patient to another clinic where the examiners are located, and the examiners grade the procedures performed by the candidates. For the scaling/calculus removal portion of the Examination, the grading criteria is that complete removal of all supra and sub-marginal calculus from each tooth, without laceration to the surrounding tissue, is required. If the tooth is not clean and/or if there is damage to the surrounding tissue, the candidate is considered to have made one (1) error. Pursuant to Board rule, each tooth is judged as a whole. Even if a candidate makes three mistakes in performing the procedure on each tooth, e.g., calculus could be above the gum, calculus could be below the gum, and/or the gum could be lacerated, only one (1) error is counted against the candidate. The examiners do not document what error was committed by the candidate, i.e., whether the error is a calculus error or a laceration error. In grading the scaling/calculus removal portion of the Examination, a grade of five is the highest grade that a candidate can receive. A five is given if there are zero to three errors found. A grade of four is given if there are four errors found. A grade of three, which is considered to be minimally competent, is given if there are five errors found. A grade of two is given if there are six errors found. A grade of one is given if there are seven errors found, and a grade of zero is given if eight or more errors are found. For an error to be counted against a candidate, at least two of the three examiners must corroborate the error, i.e., at least two of the examiners must find the error. For Ms. Kern's clinical examination, she was scored by examiners 197, 243, and 320. All three examiners participated in the standardization training and were considered qualified to act as examiners for the Examination. Ms. Kern's examination was double-blind graded. Each examiner independently graded her examination. Examiner 197 found one error. Both examiners 243 and 320 found seven errors each. Examiners 243 and 320 agreed on six of seven teeth on which errors were found. Consequently, Ms. Kern was considered to have committed six errors. A post-examination review of the examiners was conducted. Examiners 243 and 320 were found to be reliable in their scoring. However, examiner 197 was found to be unreliable in his scoring. Examiner 197 was not used again for the Examination. The scoring of six errors made by Ms. Kern on the scaling/calculus removal portion of the Examination is not arbitrary or capricious or an abuse of discretion. The scoring process is not devoid of logic and reason. However, because examiners do not document the type of error committed by a candidate, a candidate has no way of knowing what detail of a procedure was improperly performed. The candidate only knows that a procedure, as a whole, was improperly performed. Consequently, a candidate who desires to re-take the Examination has no idea what procedure needs improvement by the candidate in order to prepare for a re-taking of the Examination.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Health, Board of Dentistry enter a final order dismissing Brandy Kern's examination challenge to the clinical portion of the dental hygienist licensure examination administered in December 1997. DONE AND ENTERED this 6th day of August, 1998, in Tallahassee, Leon County, Florida. ERROL H. POWELL 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 6th day of August, 1998.
The Issue Whether Petitioner should receive a refund for an alleged overpayment of dental insurance premiums.
Findings Of Fact The Division of State Group Insurance (Division) is the executive agency within the Department of Management Services (Department) that is responsible for the administration of the State Group Insurance Program (Program). Isaacs was first employed with the State of Florida in 1993, and remained employed with the State until March 2011, when he retired. According to Isaacs, when he originally signed up for dental insurance, there were only two options available for employees; an employee could sign up either for “employee” coverage or for “employee plus family” coverage. Isaacs chose “employee plus family” dental coverage, so that he and his spouse would have coverage. During his tenure as a State employee, Isaacs was married and had no children. At all times material to the instant case, Isaacs resided, and received his mail, at 13021 S.W. 116th Street, Miami, Florida, 33186. On January 1, 2005, the State of Florida started using an online system called “People First” to manage State of Florida employee payroll and benefit packages. Every employee and retiree was given a username and password to access the online system. Each employee’s payroll information, leave balances, and benefits information could be seen online. Pursuant to section 110.123(3)(h), every year there is a finite period of time during which State employees can sign up for benefit plans, or change their existing benefit plans, for the upcoming calendar year. This period is called “open enrollment.” Prior to open enrollment every year, People First mails out, to every State employee, a package which contains a personalized benefits statement and a Benefits Guide, which contains information as to all the benefit plans that are being offered for the upcoming calendar year. The benefits statement informs employees of the benefits they currently have and will continue to have during the upcoming calendar year, unless they make changes to their insurance or coverage level. On September 7, 2007, the Division mailed each participant in the dental insurance program a letter explaining significant changes to the dental program. This letter was mailed by first class mail to the address of record for each employee who was then enrolled in the dental program. Isaacs' address of record in People First was his mailing address: 13021 S.W. 116th Street, Miami, Florida, 33186. Isaacs claims that he never received this letter. The undersigned finds this testimony to not be credible, given that Isaacs' address has not changed in 33 years, and he was unaware of any other problems with delivery to this address. The September 2007 letter advised employees that there would be new coverage levels offered in 2008. It stated, in pertinent part: There will be new coverage levels offered in 2008. You may currently be enrolled in a coverage level that will not be offered. The new coverage levels are: ° Employee Only ° Employee + Spouse ° Employee + Child(ren) ° Family You will have the opportunity during the upcoming Open Enrollment to cancel coverage, change your coverage level, or switch to another dental plan. Any change you make will be effective on January 1, 2008. If you take no action, your dental coverage may be changed automatically for 2008. If you are currently enrolled in a coverage level that will not be offered in 2008, you will be enrolled in Family coverage. People First sent Isaacs open enrollment packages in 2007, 2008, 2009, and 2010. The 2008 package, sent on September 17, 2007, included a Benefits Guide which contained all the information as to the change in the dental insurance program. Employees were placed on notice that except for employees who had previously been enrolled for “Employee” coverage, all coverage levels would be moved to “Family” coverage unless the employees made changes during open enrollment. The package included instructions on how to make the coverage changes, and how to verify that those changes had been properly made. Isaacs never changed his dental plan coverage; therefore, he was defaulted to the “Family” coverage as of January 1, 2008. Due to his failure to act, he remained in that coverage until he retired. The open enrollment packages sent to Isaacs for years 2009, 2010, and 2011 included information as to the dental coverage tiers, and a personalized Benefits Statement which indicated which benefit plans Isaacs was enrolled in, and his coverage level. Every year, he could have made changes to his dental insurance coverage, but failed to do so. As of People First going “live” in 2005, all State employees could review their benefits and coverage levels online. Thus, Isaacs, on his state-issued desktop computer, had access to People First, and could have reviewed his coverage levels and benefit plans. Isaacs admitted at hearing that he did not review the open enrollment packages he received every year because he was under the impression, based on advice he was given, that he need not review the information if he was not making any changes to his coverage levels or benefit plans. He added that he was not sure if he even opened all the open enrollment packages that were sent through the years. Isaacs had the responsibility to open, review, and carefully read the open enrollment packages and all correspondence sent to him by his employer. Isaacs was advised of the changes to the dental plan, but did not review the information sent to him. He had ample notice of the change to the dental plan coverage levels, but failed to review the information, and failed to avail himself of the many opportunities he had to adjust the coverage level. He paid for more coverage than he needed because he ignored all the information sent to him, which gave him specific instructions on how to avoid that exact circumstance.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that the Department of Management Services enter an order denying Isaacs' request for a refund for his overpayment of dental insurance premiums. DONE AND ENTERED this 15th day of November, 2011, in Tallahassee, Leon County, Florida. S JESSICA E. VARN Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 15th day of November, 2011.
Findings Of Fact At all times material hereto, Respondent has been licensed as a dentist in the State of Florida, having been issued license number DN 0009938. On August 14, 1989, patient L. F. was seen by the Respondent for dental treatment for the first time. She exercised an informed refusal of x-rays and requested only visual examination and cleaning. Respondent examined L. F., diagnosed her oral condition, and cleaned her teeth with a cavitron ultra-sonic cleaner which emits a continuous flow of water while in use. Some of this water sprayed onto L. F.'s face and clothing during treatment. Respondent then turned L. F. over to the care of his dental assistant Cheryl Toro, who polished L. F.'s teeth with a slow-speed hand-piece with a rubber cup and polishing material. Respondent informed patient L. F. that she would need a second dental cleaning for optimal dental health and noted the procedures performed that day on L. F.'s chart in his own handwriting. L. F. did not return for a second cleaning and did not keep the appointment which she had on October 9, 1989, to repair a broken filling. On October 10, 1989, L. F. was seen by Respondent complaining of hyperplasia between her upper two middle teeth. She demanded that Respondent refer her to a periodontist and that Respondent pay for her periodontal treatment. He refused. On December 14, 1989, L. F. contacted Respondent's office to find out the name of Respondent's dental assistant, advising that she was going to file a complaint against Respondent. She did file that complaint with Petitioner on December 27, 1989. Respondent has been practicing dentistry for 20 years, the last 7 of which have been in Florida. There have been no prior complaints filed against him.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is recommended that a Final Order be entered finding Respondent not guilty of the allegations contained in the Administrative Complaint and dismissing the Administrative Complaint filed against him in this cause. RECOMMENDED this 25th day of July, 1991, at Tallahassee, Florida. LINDA M. RIGOT 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 day of July, 1991. APPENDIX TO RECOMMENDED ORDER, CASE NO. 90-7811 Petitioner's proposed findings of fact numbered 1 and 2 have been adopted either verbatim or in substance in this Recommended Order. Petitioner's proposed findings of fact numbered 3, 5, and 6 have been rejected as not being supported by the weight of the credible evidence in this cause. Petitioner's proposed findings of fact numbered 4 and 7-9 have been rejected as being unnecessary for determination of the issues herein. Respondent's proposed findings of fact numbered 1, 9, and 10 have been rejected as not constituting findings of fact but rather as constituting conclusions of law or argument of counsel. Respondent's proposed findings of fact numbered 2-8 have been adopted either verbatim or in substance in this Recommended Order. COPIES FURNISHED: Albert Peacock, Esquire Department of Professional Regulation Northwood Centre, Suite 60 1940 North Monroe Street Tallahassee, Florida 32399-0792 Max R. Price, Esquire Joel M. Berger, D.D.S., J.D. 1550 Madruga Avenue Suite 230 Coral Gables, Florida 33146 Jack McRay, General Counsel Department of Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-0792 William Buckhalt, Executive Director Department of Professional Regulation Board of Dentistry 1940 North Monroe Street Tallahassee, Florida 32399-0792
Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant facts are found: Petitioner Carl L. Altchiler holds licenses to practice dentistry in the States of New York (1957) and New Jersey (1973). From 1974 through 1977, petitioner was employed in Florida as an institutional dentist at the Sunland Center in Orlando and the Sumter Correctional Institution in Bushnell. He has not practiced dentistry since 1978. In June of 1980, petitioner was a candidate for Florida licensure and took the clinical or practical portion of the dentistry examination. A prerequisite for licensure is that a candidate receive a final total clinical grade of 3.0. Petitioner received a grade below 3.0 on six of the eleven procedures tested, giving him an overall grade of 2.70 on the clinical portion of the exam. A candidate for licensure with the Board of Dentistry must take both a written examination and a pracatical or clinical examination. The clinical exam consists of six parts and requires that eleven procedures be completed. These include the following: Amalgam preparation on a patient Amalgam restoration on a patient Periodontal exercise on a patient Occlusal registration and transfer Final impression Pin amalgam preparation Pin amalgam final restoration Endodontic anterior Endodontic posterior Cast gold preparation Cast gold restoration Prior to the June, 1980, clinical examination, all candidates were sent an instruction booklet which included information concerning the subject areas to be tested, the weight to be accorded each area, the procedures the candidates were to follow in taking each procedure and the grading system. The candidates also participated in a three to four hour orientation program prior to the exam, where protocol was discussed and questions regarding procedure were answered. Florida dentists who have practiced for at least five years are preselected to be examiners for the clinical portion of the dentistry exam. Approximately 23 examiners were utilized during the June, 1980, exam. Prior to arriving at the examination site, each examiner is sent the grade sheets to be utilized and the instructions to candidates. They also receive examiner and monitor instructions and forms. On the day prior to the exam, the examiners are given an 8-hour "standardization" course where the grading guidelines and procedures are discussed. This is to promote consistency and objectivity in grading. Examiners are instructed to independently grade each procedure assigned to them by awarding a grade of from 0 to 5 and indicating the appropriate number on the comment portion of the grading sheet to justify the grade assigned. They may also provide additional comments if they so desire. The grades of 0 to 5 represent the following: 0 = complete failure 1 = unacceptable dental procedure 2 = below minimal acceptable dental procedure 3 = minimal acceptable dental procedure 4 = better than minimally acceptable dental procedure 5 = outstanding dental procedure Each clinical procedure performed by a candidate is independently graded by three different examiners, and the three grades are then averaged to determine the total grade for that procedure. Among the forms which the examination monitors are instructed to utilize is a "Report of Equipment Failure." If utilized during the exam, this form is to be placed in the candidate's file containing the examiner's grade sheets. Four witnesses who were qualified and accepted as experts in the field of dentistry testified in this proceeding. Thomas Gerald Ford, Jr., D.D.S. and Allen M. Guy, D.D.S. were called on behalf of the petitioner. Dr. Ford has practiced general dentistry since 1972, is a member of various dental associations, is a dental consultant for various agencies and private organizations and has given testimony in all phases of forensic dentistry. Dr. Guy has practiced general dentistry since 1971 and is a member of various dental associations. Neither Dr. Ford nor Dr. Guy has served as a monitor or examiner for the Florida dentistry examination. Testifying on behalf of the respondent were Rupert Q. Bliss, D.D.S. and Louis Vodila, D.D.S. Dr. Bliss has practiced general dentistry since 1956, specializing in restorative dentistry, is a member of various dental associations, has taught dentistry, is currently a member of the,Florida Board of Dentistry and has served as an examiner for the Florida dental examination. Dr. Vodila has practiced general dentistry since 1956, is a former member of the Board of Dentistry and has served as Chairman of the Dental Examination for two or three exams. He presently serves, as he did in June of 1980, as the consultant and Chief Dental Examiner for the Department of Professional Regulation, Office of Examination Services. PROCEDURE NUMBER 5 Procedure Number 5, entitled "Complete Denture Evaluation" was a test of the candidate's ability to transfer the centric relation of a live patient's jaw to an articulator. The accurate transfer from the human jaw to the articulator is crucial since the denture will be constructed on the articulator and not in the patient's mouth. If the transfer is not accurate, the denture will not fit or function properly. Wax bite registrations were utilized for this procedure and the test was whether the candidate could accurately duplicate the patient's jaw relationship on an articulator. Hand articulation is not an acceptable means of determining the accuracy of the transfer and cannot simulate the articulation observed by the three examiners who graded this procedure. Petitioner received the grades of 3, 2 and 2, for an overall score of 2.33 on Procedure Number 5. The two examiners who assigned a grade of 2 noted that the centric relation was unacceptable. Other comments listed by the three examiners were that the appearance of the wax was overcontoured and that the interocclusal distance (space) was too little. Petitioner's live patient for this procedure, Beatrice King, testified that the wax bite registrations fit and felt comfortable during the June, 1980, examination. She felt that two of the three examiners were very rough with her. She noted that the one gentle examiner had no trouble placing the rims in her mouth, and that she had to blow to enable their removal. During the administrative hearing, Mrs. King inserted the wax registrations in her mouth and felt that they were still comfortable and that her bite was normal. The expert witnesses testifying for both petitioner and respondent observed the registrations inside Mrs. King's mouth during the hearing. Petitioner's two expert witnesses agreed that the wax bite registrations lacked in appearance and were overcontoured. However, they both felt from observing the registrations in Mrs. King's mouth, that the centric relation was acceptable and repeatable and that, if inserted properly, a full seating could be obtained on Mrs. King. They would have assigned a grade of 3 and 4, respectively. Respondent's expert witness observed that the rims of the wax did not match and that the back sides of the rims were touching, thus providing an obstruction to proper closing. It was also his observation that the inserted bite rims in Mrs.King's mouth had lateral movement. He felt that a grade of 2 was "very generous." PROCEDURE NUMBER 6 Procedure Number 6, entitled "(Final) Complete Denture Evaluation," consisted of the preparation of an impression of the mouth. of a completely endentulous patient. On this procedure, petitioner received grades of 1, 2 and 4, for an overall grade of 2.33. All of the examiners noted voids in the impression tray. Other comments made by the examiners included pressure areas, inablility to observe a post-dam area, the tray not being built u high enough into the vestibule and lack of retention and stability. The actual impression tray used by petitioner during the examination has been distorted by improper storage while in the custody of respondent. It therefore could not be inserted into the mouth of Mrs. King for observation by the expert witnesses who testified at the hearing. Nevertheless, upon observation of the impression tray, petitioner's two witnesses, while noting the voids and pressure areas, would assign grades of 3.5 and 4, respectively. Respondent's expert witness did not feel that the impression submitted by petitioner constituted good dentistry. Voids and pressure areas in the impression tray can cause distortions and inaccuracies in the final denture. Respondent's witness felt that the grades of 1 or 2 were "very generous." PROCEDURE NUMBER 8 Procedure Number 8, entitled "Cast Gold Cavity Preparation," was conducted on a mannequin and required candidates to complete a cavity preparation to receive a cast gold onlay. The instructions called for the preparation of an MOD onlay replacing the buccal and lingual cusps. Petitioner received grades of 2, 2 and 1 on this procedure, for an overall grade of 1.67. The comments noted on the grading sheets included a rough marginal finish, no gingival bevel, debris, the scarring of adjacent teeth, unsupported enamel and unacceptable outline form and depth preparation. Petitioner agrees that the marginal finish was rough and that the adjacent teeth were scarred. According to petitioner, this latter defect occurred when the head of the mannequin suddenly moved as a result of a loose neck screw causing the drill to slip and go through the metal bands on the adjacent teeth. Petitioner's expert witnesses observed the rough marginal finish, but found the remaining criteria satisfactory. They would assign grades of 3 and 4, respectively. Respondent's witness felt that the outline form did not match what was called for on the examination. Rather than the MOD onlay required, the outline form more resembled one for a three-quarter crown. He noted the other deficiencies marked by the examiners on the comment section of the grading sheet. He felt that the grades of 1 and 2 were consistent with what he observed. PROCEDURE NUMBER 9 Procedure Number 9, entitled "Final Gold Restoration," consisted of the candidate fabricating an onlay casting for an ivorine tooth from a dentoform in a mannequin. The procedure was graded with the gold onlay placed on the tooth within the mannequin jaw and with regard to the relationship of the onlay to the other teeth in the jaw. Petitioner received grades of 0, 1 and 2 for this procedure, for an overall grade of 1.00. The examiner who assigned a grade of 0 noted that the casting was not seated and rocked. The other two examiners did not check this comment, but did make comments pertaining to functional anatomy, proximal contour, contact and surface finish. Petitioner's expert witnesses did not observe the ivorine tooth with the gold on lay in the dentoform in the mannequin jaw. They did observe the ivorine tooth with the gold onlay and found that the onlay did not rock on the tooth. Dr. Ford, while noting a few rough edges on the casting and a little problem in the margin, found the gold to be an exact match of the tooth. He would assign a grade of 4 to this procedure. Dr. Guy, noting a rough surface finish, would assign a grade of 3.6. The ivorine tooth and the gold onlay were in the possession of the respondent until several weeks prior to the administrative hearing. Respondent's two witnesses observed the tooth and onlay prior to the last part of April, 1981, and found that the gold onlay had a slight rock to it at that time. They both admitted that the on lay now seated better on the tooth than when they first observed it, though Dr. Bliss still detected a slight rock. Dr. Vodila felt that the procedure still deserved a failing grade because of the deficiencies in the margins. Dr. Bliss, noting that the procedure could not be accurately graded outside the dentoform in the mannequin's mouth, as well as the lack of seating when he first observed it, felt that the grade of 0 was accurate and that the product failed to meet minimal standards for the practice of dentistry. PROCEDURE NUMBER 10 Procedure Number 10, entitled "Pin Amalgam Preparation," was conducted on a dentoform in a mannequin and consisted of the preparation of a tooth for amalgam restoration. Petitioner did not complete this procedure and received a grade of 0 from each of the three examiners. According to petitioner, during this procedure the head on his mannequin often made sudden movements due to a loose screw on the back of the mannequin's neck. He attempted to tighten the screw to fixate the head on several occasions, but the screw would not hold. He testified that he called the monitor over on several occasions and was told, at first, to do the best he could, and eventually, to go on to another procedure. This testimony was corroborated by the testimony of Suzette Rogers, who assisted petitioner during this procedure. A steady, stable working station is important in this type of procedure for an accurate preparation. A competent dentist is trained to and should be able to steady his work area and complete the procedure even with a loose mannequin head. As noted above, the monitors are instructed to complete a form when equipment failure is demonstrated and to insert that form into the candidate's file. No such form was found in petitioner's file. The lead examiner for the dental exam, Dr. Vodila, was never notified of any mannequin failure during the June, 1980, exam. The same mannequin head used by petitioner was also used by four other candidates before and after petitioner used it. PROCEDURE NUMBER 11 Procedure Number 11, entitled "Pin Amalgam Final Restoration," required the candidate to complete an amalgam restoration in an ivorine tooth with a pin. This procedure was to be accomplished on a prepared tooth placed in a mannequin by the monitor after the candidate turned on a light to indicate his readiness for this procedure. Petitioner apparently did not understand the directions for this procedure, no prepared tooth was placed in the mannequin, and no work product was turned in by the petitioner. A grade of 0 was assigned by all three examiners for Procedure Number 11.
Recommendation Based upon the findings of fact and conclusions of law recited above, it is RECOMMENDED that the grades awarded to petitioner on Procedures Number 5, 6, 8, 9, 10 and 11 of the clinical portion of the dentistry examination held in June of 1980 be upheld. Respectfully submitted and entered this 29th day of October, 1981, in Tallahassee, Florida. DIANE D. TREMOR, 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 29th day of October, 1981. COPIES FURNISHED: Robert Dyer, Esquire Duckworth, Allen, Dyer and Pettis, P.A. 400 West Colonial Post Office Box 3791 Orlando, Florida 32802 Carol L. Gregg, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Samuel Shorstein Secretary, Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
Findings Of Fact Background Petitioner, Richard Alan Cohen, sat for the dental licensure examination in December 1992 and received an overall score of 2.98 for the clinical portion of that examination. The minimal passing score for the clinical portion of the examination was 3.0. After receiving notification that he failed to achieve a passing score on the examination, petitioner challenged respondent's grading of three procedures, number 01, 05 and 06. Respondent rejected petitioner's challenge, and petitioner filed a timely request for a formal hearing pursuant to section 120.57(1), Florida Statutes, to contest respondent's grading of those procedures. At hearing, petitioner abandoned his challenge to the grading of procedures 01 and 05. The examination procedure During the course of the examination at issue, the candidates were called upon to exhibit, with regard to procedure 06, certain manual skills relevant to an endodonic procedure. Specifically, the candidate was required to prepare a tooth, which had been extracted and mounted in a mold, for what is commonly called a "root canal." Preparing for the procedure included the cleaning and shaping of the interior of both root canals from each apex (the tip of the root) up to the access area near the crown (top) of the tooth. Thereafter, sealant was to be sprayed into the canal, and gutta percha condensed (compressed) in the canal until it was completely filled. The goal of the procedure was to get a seal within one half to one millimeter of the apex, and to fill the canal so there were no voids. The quality of a candidate's performance on the procedure was graded by three examiners who assigned grades of 0 to 5 based on their assessment of the candidate's performance. The scores assigned were then averaged to derive the score achieved by the candidate on the procedure. In scoring, a grade of "0" represented a complete failure, a grade of "3" represented a minimally acceptable dental procedure, a grade of "4" represented a better than minimally acceptable dental procedure, and a grade of "5" represented an outstanding dental procedure. See, Rule 61F5-2.013, Florida Administrative Code. Petitioner's examination results Petitioner received a grade of 3.66 for procedure 06, based on scores of 3, 3, and 5 from the individual examiners. Although a passing score on procedure 06, petitioner's overall score on the clinical part of the examination was 2.98; a score below the minimum 3.00 required to pass that portion of the examination. According to the grade sheets, the two examiners who assigned petitioner a grade of 3 observed that petitioner failed to properly fill the canal spaces with gutta percha. In the opinion of the one examiner who testified at the hearing, such observation was based on his examination of an x-ray (petitioner's exhibit 1D) which reflected that the canal was filled beyond the apex and there appeared to be some spacing between the wall of the canal and the filling material. A review of the examination results At hearing, the proof demonstrated that the quality of petitioner's performance on that portion of procedure 06 pertinent to this case is aptly reflected on the x-ray marked as petitioner's exhibit 1D. That x-ray reflects, with regard to one of the canals petitioner filled, what is either a void or filling material beyond the apex of the root. Either event evidences a failure to properly fill the canal space, and warrants a grade of less than 5. Here, petitioner contends he should be awarded a grade of 4 for the procedure. The proof fails, however, to support his contention. If the image reflected by the x-ray is gutta percha beyond the apex, petitioner's performance on the procedure would not meet minimally acceptable dental standards and would merit a failing grade. If on the other hand, the material extending beyond the apex is sealant or the image reflected by the x-ray is a void, the procedure was acceptable, but warranted a grade of less than 5. Under such circumstances, it is concluded that the proof fails to demonstrate that the grades of 3 accorded petitioner were baseless, lacking in reason or that in deriving such grades the examiners departed from the essential requirements of law.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be rendered dismissing the subject petition. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 22nd day of February 1994. Hearings 1550 Hearings 1994. WILLIAM J. KENDRICK Hearing Officer Division of Administrative The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399- (904) 488-9675 Filed with the Clerk of the Division of Administrative this 22nd day of February
The Issue The basic issue in this case is whether the Petitioner, Maria I. Galarza, is eligible to take the dental mannequin exam. The Board proposes to deny the Petitioner's application to take the exam on the grounds that the Petitioner's dental degree from the Universidad Central del Este in the Dominican Republic is not the equivalent of four academic years of dental education. The Petitioner contends her degree is equivalent and meets the criteria for taking the dental mannequin exam.
Findings Of Fact Facts stipulated to by all parties Petitioner sought approval of the Board to take the manual skills (mannequin) examination as an avenue toward being certified for licensure as a dentist in Florida with an application dated September 17, 1991. 1/ With her application, Petitioner submitted sufficient evidence to establish that she graduated from high school in Puerto Rico; received a bachelor of arts degree from a college in Puerto Rico; graduated with a "titulo" or degree in dentistry from the Universidad Central del Este (UCE) in the Dominican Republic; has attained an age of more than 18 years; and had completed the National Dental Board Examination with passing scores within the ten years preceding her application. UCE is not a dental school accredited by the Commission on Accreditation of the American Dental Association or its successor agency or any other nationally recognized accrediting agency. UCE is a foreign dental school located in the Dominican Republic. It is a member of the Asociacion Latinoamericana de Facultades y Escuelas de Odontologia (ALAFO). Pursuant to statute and rules of the Board, Petitioner submitted her educational credentials to ECE for a determination as to whether she had completed the equivalent of five academic years of post secondary education including four years of dental education. The Board of Dentistry requires that all graduates of foreign dental schools have their degrees evaluated for equivalency to U.S. degrees by Educational Credential Evaluators, Inc. (hereafter ECE). ECE is headed by Dr. James Frey. ECE has evaluated numerous dental degrees for graduates of Universidad Central del Este. In August 1990 ECE changed its opinion of the degree. ECE believes its previous evaluations finding the degree equivalent are erroneous. The Petitioner attended the UCE dental program from September 1979 to September 30 ,1982. UCE awarded Petitioner credit for previously completed course work and did not require Petitioner to take or complete the following courses in UCE's dental curriculum: Mathematics (4 credits) Literature (9 credits) Philosophy (undetermined credits) Sociology (undetermined credits) Physics (8 credits) Biology (4 credits) UCE has a dental program consisting of three academic semesters per calendar year. Dr. Frey testified that a four year dental degree requires a minimum of 120 semester hour credits. He determined that Ms. Galarza achieved the equivalent of 101.5 semester hours of credit at Universidad Central del Este. Dr. Frey also determined that UCE granted her the equivalent of fourteen additional semester hours of credit for course work already taken at the University of Puerto Rico. The University of Florida has the only accredited dental program in the State of Florida. At the University of Florida, dental students attend courses for three academic semesters per calendar year and the dental curriculum lasts for 3.66 calendar years and a total of eleven semesters. The Board, based upon its review of the Petitioner's credentials and the report from ECE determined the Petitioner has not completed four academic years of post secondary dental education. The Petitioner disagrees with the Board's determination. Facts based on evidence submitted at hearing The dental mannequin examination is an examination given to graduates of dental schools that are not accredited by the American Dental Association. Successful completion of the dental mannequin examination is a statutory prerequisite to taking the licensure examination. The dental education program at UCE is planned as an eleven semester program and consists of approximately 63 courses, for which the university awards a total of approximately 230 credits. 2/ Eleven of the courses are described as being part of the "Curso Comina" the so-called "common courses." The eleven courses that comprise the so-called "common courses" are high school level pre-dentistry courses.3/ These pre-dentistry courses are planned as part of the first two semesters, but in actual practice are taken at random times during the program, sometimes as late as the last semester. The eleven courses that make up the so-called common courses" represent a total of approximately 39 credits 4/ as follows: Mathematics 011 (or 101) 4 Literature 011 (or 101) 5 Phylosophy [sic] 2 Sociology 2 Physics 011 (or 101) 4 Biology 4 Literature 102 4 Dom. Soc. History 2 Mathematics 012 (or 102) 4 General Chemistry 4 Physics 012 (or 102) 4 Total "common course" credits 39 The Universidad Central del Este awarded the Petitioner a total of approximately 233 credits, including the credits that were awarded for either successful completion of, or for exemption from, the so-called "common courses." When the credits for the so-called "common courses" (which as noted above are pre-dentistry courses) are subtracted from the total credits awarded, the Petitioner's transcript reflects a total of approximately 194 credits of dental education. One credit at the dental education program at UCE represents the equivalent of approximately one-half of a semester hour credit at a dental education program in the United States. Accordingly, the Petitioner's 194 credits of dental education at UCE are the equivalent of approximately 97 semester hours at a dental education program in the United States. 5/ A full four-year dental program in the United States consists of a minimum of 120 semester hours of credit, and usually consists of 128 semester hours of credit. The standard length of a semester in a United States dental education program consists of 15 or 16 teaching weeks. The standard length of a semester at the University of Florida dental program is 16 teaching weeks. The length of the typical semester at the Universidad Central del Este consists of 13 or 13.5 teaching weeks. The Petitioner completed all of her course work at UCE during a period of eight consecutive semesters. During her eighth semester the Petitioner began work on her thesis. During that same semester her transcript reflects that she was also taking at least eleven courses totaling 44 hours of credit. 6/ During her ninth semester at UCE, the Petitioner did not take any classes, but spent all of her time working on her thesis. Educational Credential Evaluators, Incorporated, is the only agency approved by the Board of Dentistry to review foreign educational credentials. No other agency has ever been denied approval by the Board. Although the Board's rules permit other organizations to be approved, no other entity has ever requested to be approved by the Board. Educational Credential Evaluators, Incorporated, provides an evaluation of credentials to determine the quantity of education obtained at a foreign school in terms of the United States educational system. At one time Educational Credential Evaluators, Incorporated, was of the opinion that the dental education program at the Universidad Central del Este was equivalent to four years of dental education in the United States. The educational credentials of one of the Petitioner's classmates who also graduated from the UCE dental program in 1982 were earlier evaluated by Educational Credential Evaluators, Incorporated, and determined to be equivalent to four years of dental education. In 1990, following receipt and review of additional information about the dental program at UCE, Educational Credential Evaluators, Incorporated, concluded that its prior opinion was incorrect. The additional information that formed the primary basis for the change of opinion was that UCE was regularly waiving the so-called "common courses" on the basis of students' prior high school work and that UCE semesters were comprised of only thirteen or thirteen and a half teaching weeks. Educational Credential Evaluators, Incorporated, is now of the opinion that the dental program at UCE is the equivalent of only 3.66 years of dental education. 7/ Upon review of the Petitioner's educational credentials from UCE, Educational Credential Evaluators, Incorporated, concluded that she had actually completed the equivalent of only three and one-quarter years of dental education. 8/ This conclusion did not allow any credit for courses that were waived by UCE based on courses taken by the Petitioner at the University of Puerto Rico. The Board of Dentistry has a Credentials Committee that evaluates all applications to take the dental licensure examination, the dental hygiene licensure examination and the dental mannequin examination. The Credentials Committee reviews the educational credentials of applicants who have graduated from foreign dental schools. In its evaluation of foreign credentials, the Board of Dentistry does not accept as part of the statutorily required dental education any credit for course work completed at an undergraduate institution. Since 1987, the Board of Dentistry has relied upon reports from Educational Credential Evaluators, Incorporated, along with its own review of dental school transcripts, licensure applications, and national board examination scores, to determine the eligibility of applicants to take the dental mannequin examination. The Board has always accepted the recommendation of Educational Credential Evaluators, Incorporated, as to the equivalency of dental education. Prior to 1990, the Board of Dentistry generally accepted a dental education from the Universidad Central del Este as meeting the requirement for dental education set forth in the statutes. In 1990, based upon a report from Educational Credential Evaluators, Incorporated, which tended to confirm some of the Board's suspicions regarding the dental program offered at UCE, the Board changed its position regarding the equivalency of a UCE dental education.
Recommendation On the basis of all of the foregoing, it is RECOMMENDED that a Final Order be entered in this case concluding that the Petitioner has failed to prove by a preponderance of the evidence that she has received the equivalent of four academic years of dental education, concluding that the Petitioner is not eligible to take the dental mannequin examination, and dismissing the petition in this case. DONE AND ENTERED at Tallahassee, Leon County, Florida, this 31st of March, 1992. MICHAEL M. PARRISH, 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 31st day of March, 1992.
Findings Of Fact An accusation was filed against Respondent by the Petitioner complaining that Respondent had allowed unlicensed personnel to perform certain acts and duties which required a license to perform. Subsequently the parties stipulated that Respondent's license to practice dentistry shall be suspended for a period of six months effective July 25, 1977. The opera- tion of said suspension will be cancelled thirty days after said date and thereafter Respondent will remain on probation, subject to periodic review for the remaining five months. Respondent admits that the facts set forth therein do constitute a violation of Sections 466.02, 466.04 and 466.24, Florida Statutes. The Petitioner in its final order dated July 25, 1977 accepted the stipulation and entered an order essentially quoting the stipulation: Ordered and adjudged: Respondent's license to practice dentistry shall be suspended for a period of six months effective July 25, 1977. The operation and said suspension will be cancelled thirty days after said date and thereafter Respondent will remain on probation, subject to periodic review for the remaining five months. On or about November 14, 1977 a second administrative accusation was filed by the Petitioner against Respondent Davis. It charged Respondent in part as follows: That during the thirty day period in which the license of James R. Davis, III, D.D.S., was suspended pursuant to the final order, James R. Davis, III, D.D.S., continued to operate and maintain his dental practice by allowing his assistants, employees, and other licensed dentists to see and examine his patients, perform dental treatment and charge for dental services rendered. That, based upon the above allegations, James R. Davis, III, D.D.S., has violated the laws of Florida and the standards of his profes- sion because he has been guilty of misconduct in his business affairs in such a manner as to bring discredit upon the dental profession in violation of Florida Statutes Section 466.24(3)(a. Respondent requested subject administrative hearing. The Petitioner, Florida State Board of Dentistry, contends that the Respondent violated the suspension order by continuing to operate and maintain his dental practice by allowing his assistants, employees, and two dentists to see and examine his patients, perform dental treatment, and charge for dental services rendered. Respondent, James R. Davis, III, contends that he did not violate the suspension order and denies that he has violated the laws of Florida and the standards of his profession, or that he has been guilty of misconduct in his business affairs in such a manner as to bring discredit upon the dental profession. The depositions of Thomas Guilday, Esquire and Michael Huey, Esquire and Richard Langley, Esquire were admitted by stipulation into evidence. The testimony of Dr. William B. Kent III, Dr. Bruce Mitchell, Jr., Sally Dawson, Charlotte Mullins, and Dr. James R. Davis III were presented in person. Other documentation pertinent to this hearing was admitted into evidence. The proposed Orders and memorandums were considered. The Respondent, Dr. Davis, has practiced dentistry since 1971 as an employee of a Professional Association, James R. Davis, III, D.D.S., P.A. During the period beginning July 25, 1977 and continuing up to and including August 25, 1977, Dr. Davis did not personally practice dentistry in any manner. He was out of the city and on vacation the major part of that time. Richard Langley, an attorney for Dr. Davis, informed Dr. Davis that the suspension did not pertain to the Professional Association offices of Dr. Davis or to its employees. It was the understanding of Mr. Langley through conversation with two attorneys for the Petitioner, Mr. Guilday and Mr. Huey, that the suspension by the Board went to Dr. Davis personally, and not to the Professional Association owned by Dr. Davis. Neither the Stipulation nor the Final Order which preceded this hearing mentioned the Professional Association and both are styled "Florida State Board of Dentistry, Petitioner, versus James R. Davis, Respondent." The Articles of Incorporation of James R. Davis III, D.D.S., P.A. is a matter of record having been filed August 16, 1971. The Professional Association is also indicated by his professional signs. Dr. William B. Kent, III and Dr. W. Bruce Mitchell, Jr. were issued Board of Dentistry duplicate licenses to practice dentistry in the Respondent Davis' dental offices at 826 DeSoto Street, Clermont, Florida. Doctors Kent and Mitchell practiced dentistry as associates or employees of James R. Davis III, D.D.S, P.A. during the period of Dr. Davis' suspension and absence. There are no guidelines, rules or regulations promulgated by the Petitioner Board which would have given Respondent Davis notice that the suspension would include his Professional Association and its employees. He was not notified verbally. It cannot be assumed that Dr. Davis would close his office except as to a secretary informing those who called that Dr. Davis would not be in for a month, as Petitioner contends he should have. A dentist would not abandon his practice for such a period of time without making provisions for patients, particularly emergency situations absent a clear direction to do so. There is no evidence to show that he was to close the office.
Recommendation Enter an order finding that James R. Davis III is not guilty of violating the laws of Florida and the standards of his profession. DONE and ENTERED this 6th day of March, 1978, in Tallahassee, Florida. DELPHENE C. STRICKLAND Hearing Office Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: L. Haldane Taylor, Esquire 2516 Gulf Life Tower Jacksonville, Florida 32207 James B. Byrne, Jr., Esquire 1335 CNA Building 255 South Orange Ave. Orlando, Florida 32801 J. Michael Huey, Esquire Huey and Camper 1020 East Lafayette Street Tallahassee, Florida 32301 Richard H. Langley, Esquire Post Office Box 188 Clermont, Florida 32711
