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
Findings Of Fact Respondent Starla K. Rose, was at all times material hereto a licensed real estate broker in the State of Florida, having been issued license number 0046404. On February 25, 1985, an Information was filed in the Circuit Court of the Seventh Judicial Circuit, Broward County, Florida, charging Respondent with one count of grand theft, Sections 512.014(1)a and b and 512.014(2)b, Florida Statutes, two counts of insurance fraud by false or fraudulent claims Section 517.234(1)(a)1, Florida Statutes; and, one count of false report of the commission of a crime, Section 817.49, Florida Statutes. Respondent pled not guilty to the Information. On June 6, 1985, a verdict was rendered which found Respondent guilty of one count of grand theft, one count of insurance fraud by false or fraudulent claims and one count of false report of the commission of a crime. The court adjudged Respondent guilty of issuing a false report of the commission of a crime, withheld adjudication of guilt on the remaining counts, placed Respondent on probation for 3 years, and ordered her to pay costs. Respondent filed a timely motion for new trial following rendition of the verdict. At the time of final hearing in this case, no disposition had been made of Respondent's motion for new trial.
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
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 Tommy J. Dorsey is licensed as a dentist by the Petitioner and was so licensed at all times relevant hereto. During the period August-September 1978 to June-July 1979 Priscilla Mae Young was employed by Respondent as a dental assistant. Miss Young worked part- time for Respondent while doing her internship at Southern College and, upon graduation as a dental assistant, she worked full time for Respondent until she was fired in July 1979. Miss Young was not licensed as a dental hygienist or otherwise by the Petitioner during the time she worked for Respondent. During most of the time Miss Young worked for Respondent, Respondent also employed Errol A. Cherry, a licensed dentist, on a part-time basis (two and one-half days per week). While Dr. Cherry worked for Respondent, he dated Miss Young occasionally but they split up before Miss Young departed Respondent's employ in July 1979. Miss Young testified that she and the other unlicensed assistants took all impressions for dentures and partial dentures during the time she was employed by Respondent. She also testified she performed other services for Respondent, such as removing sutures, signing prescriptions, and taking and developing X-rays, all with Respondent's knowledge and consent and as part of her duties. Evidence respecting these services is disregarded as not encompassed within the Administrative Complaint. Miss Young also testified she discussed these unauthorized functions she was performing with Dr. Cherry and, finally, with Respondent. When she refused to come to work on 5 July 1980, after being denied permission to take that day off by Respondent, Miss Young was fired. Dr. Cherry testified that he never saw Miss Young take impressions, never heard Respondent direct her to do so, or talk to her about performing these services. Respondent's wife, Virgie Dorsey, is a licensed dental hygienist who works in the office primarily as a receptionist. She testified she never saw Miss Young take final dental impressions but believes that on occasion Respondent allowed his assistants to take study impressions. Respondent testified that he never permitted unlicensed personnel to take final impressions or sign his name to prescriptions. He dictated the description of the work desired on these lab prescriptions for the assistant to write down, then he would sign the prescription. Respondent occasionally allowed his assistants to take study impressions. Respondent described Miss Young as very aggressive and one he had to reprimand on three occasions, two of these occasions for signing prescriptions. When she asked for 5 July 1980 off, Respondent told her if she did not come to work that day she would be dismissed. Respondent testified he was relieved to have this excuse to fire Miss Young. Miss Young is a credible witness. On the other hand, the testimony of Respondent and his two other assistants is also credible.
The Issue This is a license discipline case in which the Respondent has been charged in a Corrected Administrative Complaint with a violation of Section 466.028(1)(m), Florida Statutes.
Findings Of Fact At all times material to this proceeding, the Respondent, Dr. Merle N. Jacobs, has been licensed to practice dentistry in the State of Florida. He currently holds license number DN 0005940. During the period from January 22, 1993, through March 27, 1995, T. C. was a patient of the Respondent. During that period of time, the Respondent performed various dental services for T. C., including the making and fitting of a partial denture. The Respondent prepared and kept dental records and medical history records of his care of patient T. C. The Respondent's records of such care are sufficient to comply with all relevant statutory requirements. The Respondent's records of such care do not include any notations specifically identified or captioned as a treatment plan. The records do, however, include marginal notes of the course of treatment the Respondent intended to follow in his care of patient T. C. Those marginal notes describe the treatment the Respondent planned to provide to patient T. C.
Recommendation On the basis of all of the foregoing it is RECOMMENDED that a Final Order be issued in this case dismissing all charges against the Respondent. DONE AND ENTERED this 29th day of May, 1998, in Tallahassee, Leon County, Florida. MICHAEL M. PARRISH 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 29th day of May, 1998.
