Findings Of Fact A. C. Porterfield currently holds Dental Laboratory Registration Certificate No. 698 for the Edgewater Dental Laboratory, said certificate having been issued on December 5, 1974 by the Florida State Board of Dentistry. A. C. Porterfield is the owner of the Edgewater Dental Laboratory. A. C. Porter field obtained registration of Edgewater Dental Laboratory in accordance with an application for dental laboratory registration which was filed with the Florida State Board of Dentistry. In his application A. C. Porterfield gave the answer "no" to the following question: "Has any owner, partner, officer, director, stockholder, or employee ever been a party to any civil, criminal, or administrative proceeding involving any violation of any statute, rule, or regulation governing the practice of any profession, or of any violation involving the regulation of narcotics or other drugs?" In his application A. C. Porterfield gave the answer no to the following question: "Has any owner, partner, officer, director, stockholder, or employee ever been convicted of any offense involving moral turpitude?" On June 16, 1966, A. C. Porterfield pleaded guilty to an information charging him with the crime of illegal practice of dentistry. Porterfield was adjudged guilty of that offense, and was sentenced to serve one year in prison. On September 11, 1968, A. C. Porterfield was granted a full and complete pardon, and his full and complete civil rights were restored to him. Applications for dental laboratory registration are initially processed by the Executive Director of the Board of Dentistry. If no irregularities appear on an application, the Executive Director processes the application and issues a registration certificate. If irregularities do appear on the application, the Executive Director forwards the application to the members of the Board for further action. The application for registration filed by A. C. Porterfield was processed in this manner. No irregularities appeared on the face of the application, and the registration certificate was therefore issued by the Executive Director. If either of the questions set out above had been answered in the affirmative, the Executive Director would have forwarded the application to the members of the Board for further action. If the application had been forwarded to members of the Board it would have received careful consideration by them, and at least some members of the Board would have voted not to issue the registration certificate. There was not sufficient evidence adduced at the hearing to substantiate a finding that A. C. Porterfield intentionally misled the Board by answering the above questions in the negative. Porterfield apparently did not read the questions carefully, and may have been con fused about the effect of his pardon. It is evident that the answers to the questions were erroneous. If the questions had been answered affirmatively, the application would have been processed differently, and may have been denied.
The Issue The issues in this case are framed by the Notice of Intent to Issue an Order to Cease and Desist, filed by the Florida Insurance Commissioner on August 18, 1992, Dept. of Insurance Case No. 92-CA-058EMM, as modified by the parties' Joint Prehearing Stipulation, filed on March 18, 1993. The Cease and Desist Order alleges in Count I essentially that the United Dental Program of America (UDP) 2/ is a dental service plan that has been operating in Florida, through one or more of the named (and unnamed) individual respondents, without the authorizations required by Chapter 637, Part III, Fla. Stat. (1991). Count II alleges essentially that, in so operating, UDP and one or more of the other respondents were guilty of various deceptive acts or practices prohibited by either Chapter 637, Part III, or by Chapter 624, Fla. Stat. (1991). In the parties' Joint Prehearing Stipulation, the Department of Insurance dropped all of the alleged deceptive acts or practices except the allegation that sales solicitation materials falsely guaranteed savings of 60 percent or more under the UDP product. Count III alleges essentially that UDP has been transacting insurance in Florida, through one or more of the named (and unnamed) individual respondents, without the authorizations required by Chapter 624, Fla. Stat. (1991). The Cease and Desist Order also seeks an administrative penalty against UDP in an amount not to exceed $1,000 per violation, and an administrative penalty of $10,000 against each of the other respondents for each dental service plan contract or insurance contract offered or effectuated in Florida.
Findings Of Fact At the time the Florida Insurance Commissioner filed the Notice of Intent to Issue an Order to Cease and Desist in this case, UDP was incorporated in the State of Delaware as United Dental Plan of America, Inc. On December 23, 1992, UDP filed a name change with the Secretary of State of Delaware, and the company has since been incorporated as United Dental Program of America, Inc. Before and after the name change, the company has been referred to as UDP, and the acronym "UDP," when used in this Recommended Order, may refer to the company either before or after the name change. The Department and UDP stipulated that, prior to August 18, 1992, Bob Rose, a/k/a Robert Rosenfeld, by a nationally accessible electronic telephone system, recorded a message of solicitation to subscribers, UDP sales associates, and potential sales associates, which was directed, in part, to Florida residents. They also stipulated that respondents Paul Sheldon, William C. Stinnett, Phillip Young, Richard A. Gilbert, John C. Sparks, Jean Joseph and Nick Virenza, a/k/a Nick Verrengia were UDP sales associates who sold UDP memberships in Florida prior to August 18, 1992. The individual named respondents did not enter into the stipulation referred to in the preceding paragraph. However, the UDP stipulation is viewed as evidence on which the findings in the preceding paragraph can be based. Prior to August 18, 1992, without Department approval, UDP sales associates in Florida, including the named respondents referred to in Finding 2, were active in selling subscriptions to UDP's Dental Program to Florida residents, and held meetings for the purpose of selling the Dental Program and recruiting sales associates. There are 1,981 subscribers in the State of Florida. There was no evidence as to which of the 1,981 subscriptions sold in the State of Florida were sold by which of the individuals identified in Finding 2. UDP is not, and has never been, licensed under the Florida Insurance Code. UDP sells an annual membership to its subscribers. There is an individual membership costing $85 a year and a family membership costing $150 a year. If UDP resumes operations in Florida, the annual fees will be $140 for senior couples, $155 for other couples, $170 for families, $80 for senior individuals, and $95 for other individuals. Subscribers are given a one year membership card. For one year from the subscription date, the subscriber receives an annual no-cost dental checkup and x-rays pursuant the UDP subscriber and provider agreements. Subscribers are provided a list of dentists in their geographic area (and elsewhere, if requested) (a "dental directory") who have entered into an agreement with UDP to be on the list. By agreeing with UDP to be on the list, dentists agree that, if they accept a subscriber who has not yet had his or her annual checkup and x-rays, they will do the checkup and x-rays at no cost. They also agree to charge the subscriber for other dental services performed during the subscription year in accordance with a schedule of presumptively reduced fees or, if a procedure is not scheduled, for a 25 percent discount from their usual and customary fees. UDP marketing materials assert that the scheduled fees are lower than the "typical costs." If participating dentists accept subscribers, they agree to abide by the agreement with UDP described in the preceding paragraph. The participating dentists are not obligated to accept subscribers as patients. They have "the right within the framework of professional ethics to reject any patient seeking [their] professional services." The contractual documentation does not further clarify whether, once a participating dentist begins a procedure for a subscriber, the dentist is obligated to complete it or whether, once a procedure is completed for a patient, the dentist is required to accept the patient if the patient returns for additional procedures or services. Notwithstanding the unclear contractual provisions, UDP professes a desire to effectuate an understanding with participating dentists that they will accept UDP patients "on an equal basis" with their other patients. It is not clear how UDP would propose to reach or enforce this understanding. Subscribers are free to use, or attempt to use, any dentist on the list, or directory, and are free to change dentists as often as they choose. (They also remain free to use any dentist not on the list, or directory, under any financial arrangements to which the patient and dentist might agree, but they would not be entitled to benefits under the UDP program.) Except for the annual checkup and x-rays, they are obligated to pay the discounted fees directly to the dentist. Under the UDP program, they expect, and are entitled to, no payment from UDP, either to them or to the dentist. Dentists who agree to participate in the UDP program are also free to maintain their own private practice and to participate in any other dental insurance or plan or program that they wish. Under the UDP program, they expect, and are entitled to, no payment of any kind from UDP. If they perform the free annual checkup and x-rays for a subscriber, they receive no payment from any source for those services. If they perform no other services for a subscriber, the dentists have no recourse against either the patient or UDP. If they perform other services for a subscriber, they are entitled to look only to the subscriber for payment, and only in accordance with the UDP fee schedule, or 25 percent discount, whichever applies. UDP is not liable to the dentists for payment of any part of a subscriber's fees. If the subscriber does not pay, the dentists have no claim against UDP. Under the UDP program, the dentists who agree to participate in the UDP program are solely responsible for dental advice and treatment. UDP has no control over the dentist's practice, rates charged (except insofar as the UDP fee schedule applies, or 25 percent UDP discount is necessary), the dentist- patient relationship, or the dentist's personnel or facilities. UDP and the dentists who agree to participate in the UDP program also agree that the dentists will maintain malpractice insurance coverage for their practices in an amount not less than $300,000 per incident. The dentists must provide UDP with a copy of the malpractice insurance. There was evidence that an early brochure developed by UDP before 1992 contained an untrue guarantee of savings of at least 60 percent. But there was no evidence on which a finding of fact can be based that UDP, through any representative, whether or not named as a respondent to this proceeding, ever delivered a copy of the brochure, or made the misrepresentation, to anyone, much less someone in Florida. In addition, other information also was developed contemporaneously from which it could be determined that savings of at least 60 percent were not guaranteed. The Department first notified UDP that the Department believed UDP and the other named respondents were in violation of the Florida Insurance Code by letter dated March 5, 1992. Between March 5, and August 18, 1992, UDP and the Department engaged in numerous informal telephone and written communications through which UDP attempted in good faith to persuade the Department that UDP was not subject to regulation under either Chapter 637, 624 or 626 and that UDP was not in violation. It was not established how many, if any, of the 1,981 subscriptions UDP sold in Florida occurred after March 5, 1992. According to the Joint Stipulation between the Department and UDP, none of the subscriptions were sold after August 18, 1992, the date of the Cease and Desist Order issued against UDP and the other named respondents. There was no evidence contrary to this stipulation.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is recommended that the Insurance Commissioner enter a final order: (1) finding that United Dental Program, Inc. (UDP) is a dental service plan corporation subject to regulation under Part III, Chapter 637, Fla. Stat. (1991); (2) finding that individuals who represent UDP are subject to regulation under Section 637.415, Fla. Stat. (1991); (3) finding that UDP and some of its representatives sold 1,981 subscriptions in Florida without having the authorization required under Part III, Chapter 637, Fla. Stat. (1991); (4) requiring UDP and the individual respondents named in Finding 2 to cease and desist from operating the UDP dental service plan corporation in Florida without having the authorizations required under Part III, Chapter 637, Fla. Stat. (1991); and (5) assessing against UDP an administrative penalty in the amount of $5,000. RECOMMENDED this 23rd day of April, 1993, in Tallahassee, Florida. J. LAWRENCE JOHNSTON 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 23rd day of April, 1993.
The Issue Whether Respondent failed to comply with a valid order of the Board of Dentistry and, if so, what disciplinary action should be taken against Respondent’s license to practice dentistry.
Findings Of Fact Petitioner, the Department of Health, is the state agency charged with regulating the practice of dentistry pursuant to Chapters 455 and 466, Florida Statutes. However, at the time the complaint in this cause was filed, this responsibility was assigned to the Agency for Health Care Administration. At the time the Final Order which is the subject of this proceeding was entered, this responsibility was assigned to the Department of Business and Professional Regulation. Respondent, Arnold G. Clement, is now and was at all times material hereto a licensed dentist in the State of Florida, having been issued license number DN 0002500. Respondent’s last known address is 1405 Lennox Road East, Palm Harbor, Florida 34683. On April 22, 1993, the Department of Business and Professional Regulation, Board of Dentistry, entered a Final Order in DPR Case Nos. 90-3628, 90-4117, 0092038, and 0092039 (Final Order), a prior disciplinary action against Respondent. The Final Order, which incorporated by reference an Order issued on February 16, 1993, and a Stipulation approved August 31, 1991, set forth the conditions of Respondent’s probation. Respondent’s signature is on the Stipulation and copies of the Order and Final Order were mailed to counsel representing Respondent in that proceeding. Respondent was aware of the Final Order and Order entered by the Department of Business and Professional Regulation. The Final Order suspended Respondent’s license for six months, and after the period of suspension, placed Respondent’s license on probation for three years. As a condition of probation, Respondent was required to: (1) pay an administrative fine of $2,000; (2) perform ninety-six (96) hours of community service during each year of probation; and (3) complete sixty (60) hours of continuing education in removable prosthetics. Prior to the end of his six-month suspension period, Respondent was required to submit for Board approval, a written practice plan that provided for supervision by a Board approved licensee and for submission to the Board of written reports by the supervising licensee. During the probationary period, Respondent’s practice was restricted to work involving removable prosthetics. On or about October 23, 1993, and December 7, 1993, respectively, Respondent submitted to the Board the required Medical Practice Plan and Dental Practice Plan. These plans were apparently approved by the Board. By letter dated February 15, 1997, the agency reiterated the terms and conditions of Respondent’s probation. That letter provided in pertinent part the following: Pursuant to the final order filed April 22, 1993, the “hearing” held October 23, 1993 concerning the “Dental Practice Plan”, and the subsequent receipt and review of this practice plan, please note the following: * * * Probationary Conditions - 60 hours continuing education in “Removable Prosthetics. Quarterly Written Reports from Woodrow D. Wheetley, DDS, effective March/94, and continuing on a three (3) month quarter thereafter, ending December/96. Submit proof of 96 hours community service, with the first report due December/94, and continuing through December each year ending in 1996. We are requesting “Proof” be in the form of a notarized affidavit from the community service organization. The required fee of $2,000.00 is due April 24, 1994. It is your responsibility to assure that all reports are submitted timely and as specified in the final order filed April 22, 1993. . . . In the Medical Practice Plan submitted by Respondent on October 23, 1993, he agreed to: egin doing his community service work which if approved by the [B]oard would consist of seeing indigent patients at Dr. Wheetley’s office for either no fee or for the cost of the dentures only. In the Dental Practice Plan that Respondent submitted to the Board, he agreed to: egin doing his community service work consisting of removable prosthetics, which if approved by the [B]oard would consist of seeing patients referred to Dr. Clement by the Department of Health and Rehabilitative Services, Pasco Community Health Agency or any other agency as directed by the Board of Dentistry. . . . Respondent failed to submit the requisite proof that he performed ninety-six hours of community service hours for the years ending December 1994 and December 1995. In fact, no such proof was submitted at any time during Respondent’s during entire probationary period. Respondent failed to comply with the requirements of the Final Order relative to submission of quarterly written reports. Pursuant to the terms of Respondent's probation, these reports were to be submitted quarterly beginning March 1994, and continuing thereafter on at three month intervals, with the last report due December 1996. While these quarterly reports were to be prepared by the dentist supervising Respondent, it was Respondent’s responsibility to assure that all reports were timely submitted. In 1994, only two quarterly reports, not the required four, were submitted on Respondent’s behalf. The first report, due the end of March 1994, was not received by the Board until May 6, 1994. The second report was due at or near the end of June 1994, but was not submitted to the Board until November 1994. Thus, the only two quarterly reports received by the Board in 1994, were untimely submitted. Moreover, no quarterly reports were submitted by or on behalf of Respondent during the 1995 and 1996 calendar years. If Respondent had complied with the terms of and conditions of his probation as set forth in the Final Order, his probationary status would have ended in December 1996. Respondent violated the provisions of the Final Order entered in DPR Case Nos. 90-04117, 90-03628, 0092038, and 0092039 by failing to comply with the terms and conditions of his probation.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is recommended that Petitioner, the Department of Health, Board of Dentistry, enter a Final Order finding that Respondent violated a lawful order of the Board and revoking his license to practice dentistry. DONE AND ENTERED this 3rd day of December, 1997, in Tallahassee, Leon County, Florida. CAROLYN S. HOLIFIELD Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (904) 488-9675 SUMCOM 278-9675 Fax Filing (904) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 3rd day of December, 1997. COPIES FURNISHED: Craig A. McCarthy, Esquire Greg W. Files, Esquire Thomas E. Wright, Esquire Agency for Health Care Administration Office of the General Counsel Allied Health Post Office Box 14229 Tallahassee, Florida 32317-4229 Arnold G. Clement, D.D.S. 1405 Lennox Road East Palm Harbor, Florida 34683 Angela T. Hall, Agency Clerk Department of Health 1317 Winewood Boulevard Building Six Tallahassee, Florida 32399-0700
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.
Findings Of Fact Paul M. Leyden was licensed as a dentist in Florida in 1945 and was so licensed at all times here relevant. Helen Hampton went to Sheppard Dental Center on September 21, 1981, to have crowns on her lower teeth replaced and was referred to Respondent for consultation and treatment. At this initial appointment Respondent examined the crowns Ms. Hampton wanted replaced, viewed X-rays that Ms. Hampton had brought with her of these teeth, and advised Ms. Hampton that the existing crowns appeared to be alright. Ms. Hampton did not like the appearance of these crowns and wanted them replaced. An appointment to do this work was made. On October 1, 1981, Respondent removed the existing crowns on teeth Nos. 20 through 28 of Ms. Hampton and took impressions for replacement crowns. Decay was noted on teeth Nos. 21 and 22, the decay was removed, and the space left thereby cemented. The teeth were prepared and temporary crowns put on pending the construction of the permanent crowns by the laboratory. Ms. Hampton was given an appointment for October 12, 1981, to have the permanent crowns seated. The laboratory was two days late and on October 15, 1981, the permanent crowns were seated by Respondent. Ms. Hampton was pleased by the appearance of these crowns. On October 19, 1981, Ms. Hampton returned to Respondent for replacement of crowns on teeth Nos. 2, 3, 4, 9, and 14. At this time she complained of pain in the lower jaw where crowns had recently been put. At this time Ms. Hampton wanted tooth No. 24 redone but this was postponed until the crowns were replaced on the upper jaw on November 5, 1981. When Ms. Hampton first visited Respondent, he observed some irritation in her gums and prescribed a penicillin mouthwash. Subsequently, when Ms. Hampton complained about soreness in the lower jaw where crowns had been placed on teeth Nos. 20 through 28, Respondent again prescribed penicillin mouthwash. Before the crowns were replaced, he relied upon the X-rays Ms. Hampton provided. After the crowns had been replaced and Ms. Hampton complained of pain and soreness, no additional X-rays were taken. Respondent told Ms. Hampton that she could expect soreness for sometime after new crowns were installed Ms. Hampton's testimony that Respondent told her she could experience pain for two years after crowns were installed was denied by Respondent, who testified that he advises all his patients that crowns can be sensitive for three to six months. On November 23, 1981, when the redone crown was replaced on tooth No. 24, Ms. Hampton again complained of pain in the lower jaw and Respondent suggested she use a water pic. Ms. Hampton called the Sheppard Dental Center several times to talk to Respondent about the pain in her lower jaw, but was unable to make contact with him. When Respondent tried to return her calls, she was out. On December 14, 1981, Ms. Hampton did speak with Respondent on the telephone and complained about the pain. Respondent prescribed penicillin mouthwash with Phenaphen and suggested Ms. Hampton make an appointment for him to check her teeth. By this time Ms. Hampton had been in Respondent's office three times since he had placed the crowns on teeth Nos. 20 through 28, each time she complained of pain in those teeth, and each time Respondent had done other work in her mouth, paid scant attention to her complaints, and left Ms. Hampton quite dissatisfied with the treatment she received. Accordingly, when Respondent, on December 14, 1981, suggested Ms. Hampton come back for him to check her teeth, she did not do so. On December 15, 1981, Ms. Hampton went to John T. Flanigan, D.D.S., complaining of pain in her lower jaw and told him she had those crowns replaced some two months ago. Dr. Flanigan took Panorex X-rays, conducted a visual examination of Ms. Hampton's mouth, found the margins on some of the crowns short, which could cause sensitivity, and suggested she go back to the dentist who had installed the crowns. He did not treat Ms. Hampton. In his deposition (Exhibit 2) taken February 1, 1983, Dr. Flanigan reviewed the X-rays of Ms. Hampton's crowns and testified that tooth No. 20 had an open and short margin on the distal side; tooth No. 21 had an open margin on the mesial side; tooth No. 28 had an open margin on the mesial side; tooth No. 29 had an open margin on the mesial side; and several teeth had short margins on the lingual side. Dr. Flanigan concluded that the crowns on teeth Nos. 20 and 21 were below minimal acceptable standards for the community. In March, 1982, Ms. Hampton went to Woodrow W. Garcia, D.D.S., complaining of pain in the lower jaw. Dr. Garcia briefly examined her, took full mouth X-rays, and told her to go back to the clinic where she had the work done. His examination revealed, inter alia, a fracture of the root of one of the capped teeth. She told Dr. Garcia it hurt so bad "and so I advised her to have it extracted but to go back to the Sheppard Dental Clinic and let them do what they had to do over there because I did not want to take that case on" (Exhibit 1 p. 8). Ms. Hampton returned to Dr. Garcia on May 3, 1982, again complaining of pain. In his deposition (Exhibit 1) Dr. Garcia appears to confuse the March and May visits, as Exhibit 1 leaves some doubt as to whether X-rays were taken on the March or May visit, or both. Regardless of when the X- rays were taken, Dr. Garcia observed some decay on the capped teeth but performed no work on Ms. Hampton. Subsequent to her last visit to Respondent, Ms. Hampton complained to Petitioner and, on March 22, 1982, she was examined by Daniel R. Manrique, Jr., D.D.S. Dr. Manrique heard the patient's complaints, took X-rays of teeth Nos. 20 through 28, and conducted a clinical examination on Ms. Hampton. The radiological examination revealed (Exhibit 5): Tooth No. 20 - distal margin open and short Tooth No. 21 - mesial margin open and short Tooth No. 22 - mesial margin open and short Tooth No. 26 - mesial and distal margins open and short. The clinical examination revealed open margins on teeth Nos. 20 and 21 and margins short on all other teeth. On teeth Nos. 23 and 26 the margins were short as much as 2 mm. Dr. Manrique concluded that the work done on Ms. Hampton by Respondent failed to meet the minimum standards of the community. Following the examination of Dr. Manrique, Ms. Hampton went to a Dr. Collins and he replaced the crowns on the teeth that were bothering her. When open margins exist they can lead to decay of the tooth under the crown, as there is a space between the crown and the tooth that is not protected by enamel and can be attacked by bacteria. If the tooth is vital such decay will cause pain. A root canal had previously been done on Ms. Hampton's tooth No. 20, so this tooth was no longer vital. She would not experience pain if decay started in that tooth as she would in a vital tooth. Where short margins exist the crown does not cover the prepared surface where the enamel has been disturbed or removed by the dentist in preparing the tooth to receive the crown. Short margins can also lead to decay even if below the gingiva, as the exposed dentine is more susceptible to caries than is the tooth covered by enamel. Some tolerance in the fit of the crown over the tooth is inevitable; however, the amount of prepared tooth surface the short crown fails to cover should average about 50 microns, or .050 millimeters. Accordingly, a crown that is two millimeters short far exceeds the allowable tolerance. Since the enamel has been removed to prepare the tooth for the crown, failure of the crown to cover the prepared surface subjects the tooth to attack by bacteria where there is no enamel to provide protection. All witnesses, including Respondent, testified that the crown on tooth No. 20 should have been redone because of the open margin. The open margins on teeth Nos. 21 and 22 were also recognizable from the X-rays, as were the short margins on most of these teeth. Since the X-rays cannot penetrate the metal in the crown, all sides of the tooth cannot be observed on the X-rays that were taken. The only witness who acknowledged performing a clinical examination of Ms. Hampton while the crowns installed by Respondent were in place is Dr. Manrique. No evidence to rebut his clinical findings was submitted. Before crowns are permanently seated, it is routine dental practice to place these crowns on the teeth for which they are made to see if they fit. When doing this the dentist can observe if the crown covers the prepared surface and fits snugly to the teeth so no open margins will remain when the crown is cemented on. The crowns on teeth Nos. 20 and 21 should have been observed by Respondent to fit so poorly that open margins would exist when the crowns were permanently attached. Likewise, the crowns for teeth Nos. 23 and 26, which were short by two centimeters when examined by Dr. Manrique, certainly should have been found unacceptably short when first put on these teeth by Respondent. Leaving open margins on crowns sufficiently large that an explorer can be inserted between the crown and the tooth constitutes dental practice which fails to meet the minimum standards of performance generally prevailing in the community. Leaving margins on crowns that fail to cover as much as 1.5 to 2 millimeters of prepared tooth surface likewise fails to meet the minimum standards of performance in the community.
Findings Of Fact At all times material hereto, Respondent has been licensed to practice dentistry in the State of Florida, having been issued license number DN 0006941. In May, 1987, Respondent's son Cesar L. Palomeque was neither licensed as a dentist in the State of Florida nor as a dental hygienist. He became a licensed dentist in the State of Florida in August, 1987. Cesar L. Palomeque was employed by Respondent and worked in her office during May of 1987. At that time Respondent knew that Cesar Palomeque was not a licensed dentist or a licensed dental hygienist. In early May of 1987, J.L.'s mother and grandmother were in a cafeteria/bakery located downstairs from Respondent's dental office in Hialeah. J.L.'s grandmother struck up a conversation with a gentleman who was there. He introduced himself to the women as Cesar Palomeque, told them that he was a dentist who practiced upstairs, and encouraged them to visit him professionally since he charged quite reasonable prices. Pursuant to an appointment made by his mother, on May 13, 1987, J.L. went to Respondent's Hialeah office. On that date, patient J.L. had x-rays taken, received a prophylaxis and scheduled further treatment. He returned for that subsequent treatment on May 20, 1987. During May of 1987, Respondent's dental office consisted of a waiting area and a large operatory. The operatory consisted of three treatment bays. The treatment bays were separated from each other only by partitions which extended a few feet up from the floor. Although patients seated in a chair in one of the treatment bays could not see a patient in one of the other treatment chairs due to the partition, everything occurring within one of the treatment bays could be heard throughout the room, and a person standing anywhere in the room could see what was taking place within any of the treatment bays. On May 20th, J.L. was escorted into the operatory and placed in one of the treatment bays by Cesar Palomeque. At the time that Cesar Palomeque escorted J.L. into the operatory and placed him in one of the treatment chairs, Respondent and her dental assistant were working on a patient in the first treatment bay. Cesar Palomeque placed J.L. in one of the chairs, placed a bib on him, laid out instruments and filled the water cup. During the time J.L. was in the chair on May 20th, he was very nervous and restless since he knew he was going to have a tooth drilled and filled. He would not open his mouth and was very uncooperative. Cesar Palomeque spoke with the boy and attempted to comfort him unsuccessfully. Cesar Palomeque summoned J.L.'s mother into the operatory because J.L. was so uncooperative. J.L.'s mother came into the operatory, stood a few feet away from the chair in which her son was seated, told him to be cooperative, and stayed there observing during the balance of the treatment her son received that day. On May 20, 1987, Cesar Palomeque drilled and filled one of J.L.'s teeth. While Cesar Palomeque was drilling and filling J.L.'s tooth, Respondent could hear the disturbance created by J.L. and could see the treatment being rendered to J.L. by Cesar Palomeque. She knew at the time that Cesar Palomeque was drilling and filling J.L.'s tooth. On May 13 or on May 20, 1987, when J.L. was leaving Respondent's office, he was given a tooth brush bearing the inscription "Dr. Cesar Palomegue." Drilling and filling a tooth is a non-reversible dental procedure. It constitutes the practice of dentistry. All monies paid to Respondent for services rendered to J.L. were refunded.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is, RECOMMENDED that a Final Order be entered finding Respondent guilty of the allegations contained in the Administrative Complaint filed against her in this cause and suspending Respondent's license to practice dentistry for a period of six months. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 31st day of October, 1989. 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 31st day of October, 1989. APPENDIX TO RECOMMENDED ORDER DOAH CASE NO. 89-1964 Petitioner's proposed Findings of Fact numbered 1, 3, 4, and 7-12 have been adopted either verbatim or in substance in this Recommended Order. Petitioner's proposed Finding of Fact numbered 2 has been rejected as being unnecessary for determination of the issues in this cause. Petitioner's proposed Finding of Fact numbered 5 has been rejected as being subordinate to the issues under determination in this cause. Petitioner's proposed Finding of Fact numbered 6 has been rejected as not being supported by the weight of the evidence in this cause. Respondent's proposed Findings of Fact numbered 3-8, 10, 11, 14, and 19 have been adopted either verbatim or in substance in this Recommended Order. Respondent's proposed Findings of Fact numbered 1, 2, 9, 12, 13, 16, and 18 have been rejected as being unnecessary for determination of the issues in this cause. Respondent's proposed Findings of Fact numbered 15 and 20-23 have been rejected as being contrary to the weight of the credible evidence in this cause. Respondent's proposed Findings of Fact numbered 17 and 24 have been rejected as being irrelevant to the issues under consideration in this proceeding. COPIES FURNISHED: Jack L. McRay, Esquire Department of Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-0792 Harold M. Braxton, Esquire 9100 South Dadeland Boulevard Suite 406 Miami, Florida 33156 Kenneth E. Easley, 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 =================================================================
The Issue The issue in this case is whether Petitioner should receive a passing score on the December 2001 dental license examination.
Findings Of Fact In December 2001, Petitioner took the dental licensure examination and failed to pass the clinical portion of the exam. The examination is a three-day process involving two days of clinical examination. Those two days of clinical examination consist of nine procedures. Four of the nine procedures were challenged by Petitioner. The clinical portion is where the candidate is required to perform certain patient procedures. The work product of the student, or candidate, is evaluated following the performance of those procedures by three examiners. Each examiner grades the candidate independently of whatever score the other examiners may award on a particular procedure. Then the average grade for each procedure is weighted in accordance with requirements of Rule 64B5-2.013, Florida Administrative Code. This produces the overall score for the entire clinical exam. The Department uses three examiners' scores because this provides a more reliable indication of the candidate's competency and true score. Further, each examiner must be a licensed dentist for a minimum of five years and have no complaints or disciplinary actions against their license. Examiners have no contact with the candidate taking the examination and, accordingly, have no idea of who they are grading. To further ensure fairness, each examiner must attend and successfully complete a standardization session. The purpose of these sessions is to ensure that each examiner is trained to use the same internal grading criteria. In standardization, each examiner is thoroughly taught specific grading criteria with the result that examiners are instructed on how to evaluate the work of the candidates. The examiners who graded Petitioner’s examination had successfully completed the foregoing standardization session. Also, the Department’s post-exam check found these examiners’ grading to be reliable. Petitioner contested the score he received on Procedure 4, the Endodontic procedure, a root canal. The Endodontic procedure required removal of infected nerve tissue and blood vessels pulp from the tooth. Petitioner was required to access the canal and pulp tissue from the outside. Then, Petitioner was required to remove the bad nerve and cleanse the canal. Finally, Petitioner was required to seal the canal to prevent recurring bacteria. Petitioner failed to observe a fracture in the tooth. He claimed that a fracture to the root of the tooth was caused by the Department after he reviewed his examination and that no one advised him the root was fractured. Petitioner requested a score of 3.00 for this procedure. However, the Department's witness, Dr. William F. Robinson, a licensed dentist for 32 years who examined the tooth and X-ray prepared by Petitioner, testified that the fracture to the root was noticed in both the X-ray and on the tooth when he examined the same. Additionally, two of the three re-graders also noted the fracture of the root. With regard to Petitioner's preparation of the X-ray at the conclusion of the examination, Dr. Robinson opined that Petitioner caused the fracture to the root during the examination and not the Department, as alleged by Petitioner. Dr. Robinson further opined that even without a fracture to the root of the tooth, Petitioner failed the procedure and the failing grade he received was fair. Dr. Robinson would not recommend that Petitioner receive a passing score of 3.00 on the procedure. The examiners' comments and grades and the testimony of Dr. William F. Robinson establish that Petitioner failed to properly perform this procedure. The grade Petitioner received was fair. Petitioner challenged the grade he received on Procedure 5, the Class IV Composite Restoration of the front tooth, but did not offer any testimony at the hearing as to why the score was not correct for the procedure. Petitioner requested that the score of 1.00 given by one of the examiners be thrown out, thus giving him a passing grade on this procedure. Procedure 5 of the dental licensure examination is a procedure that involves the candidate’s ability to replace the edge of the front tooth with a composite resin material, which is a tooth-colored filling. As established by the examiners’ comments and grades and the testimony of Dr. William F. Robinson, Petitioner failed to properly perform this procedure and the grade Petitioner received was fair. Specifically, the examiners found that the tooth was abraded and the re-grader noted, as did the examiners, the excessive “flash” on the tooth. Dr. Robinson also noted both deficiencies in the procedure. Petitioner contested the score he received on Procedure 6, the Class II Composite Restoration procedure in his original petition, but offered no testimony at the hearing concerning this procedure. Dr. Robinson reviewed the examiners' grades and the tooth prepared by Petitioner and opined that Petitioner’s grade of 2.66 for this procedure is fair. Based on the examiners’ comments and grades and the testimony of Dr. Robinson, Petitioner failed to properly perform this procedure and the grade Petitioner received was fair. Petitioner contested the score he received on Procedure 7, the preparation for a 3-unit Fixed Partial Denture, claiming that on the re-grade one of the examiners reviewed the wrong procedure. The Preparation for a 3-unit Fixed Partial Denture procedure of the dental licensure examination is a procedure that involves the candidate’s ability to provide preparations of two (2) teeth in order to replace a missing tooth with a fixed bridge. Dr. Robinson established that Petitioner’s work on this procedure resulted in one tooth, No. 29, being grossly over reduced and tooth No. 31 was insufficiently reduced. The result of such work is that it is impossible to place a bridge on such an improper preparation. As established by testimony of Dr. Robinson, Petitioner's problem with this procedure resulted from Petitioner’s undercut. This undercut indicated that Petitioner’s preparations were not properly aligned to accept a bridge. Based on the examiners’ comments and grades, and the testimony of Dr. Robinson, Petitioner failed to properly perform this procedure and the grade Petitioner received was fair. The Department's “re-grade” process was utilized in this case. Used to give all candidates who timely request a hearing another chance at passing, the re-grade process allows the Department to go back and determine whether any grades rendered were inconsistent. The Department selects the top three examiners who had the highest reliability from that examination to participate in the re-grade process. The Department maintains post-standardization statistics of the examiners’ performance. In this case, those statistics indicated that Petitioner’s examiners graded reliably. In addition, the Department calculates post- examination statistics for the examiners, which are as follows for the examiners who graded Petitioner’s challenged procedures: Examiner Accuracy Index & Rating #206 95.8-Excellent #375 98.8-Excellent #380 92.1-Good #334 97.8-Excellent #298 95.9-Excellent #375 98.8-Excellent-was an original and a re-grader. All of Petitioner's examiners exhibited a reliability significantly above the minimum acceptable accuracy index of 85.0.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered dismissing Petitioner's challenge to the grade assigned him for the December 2001 dental licensure examination. DONE AND ENTERED this 9th day of October, 2002, in Tallahassee, Leon County, Florida. DON W. DAVIS Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 9th day of October, 2002. COPIES FURNISHED: E. Renee Alsobrook, Esquire Department of Health 4052 Bald Cypress Way Bin A02 Tallahassee, Florida 32399-1703 Jason S. Baker, D.M.D. Westchester Medical Center 95 Grasslands Road, Box 572 Valhalla, New York 10595 R.S. Power, Agency Clerk Department of Health 4052 Bald Cypress Way Bin A02 Tallahassee, Florida 32399-1701 William W. Large, General Counsel Department of Health 4052 Bald Cypress Way Bin A02 Tallahassee, Florida 32399-1701
