Findings Of Fact Introduction At all times relevant hereto, respondent, Arthur E. Wollman, held dentist license number DN 0006476 issued by petitioner, Department of Professional Regulation, Board of Dentistry (DPR or the Board). The record does not reflect how long respondent has been licensed, but he has practiced dentistry in South Florida since at least 1979. He presently resides at 2212 Marble Way, Boca Raton, Florida. When the events herein occurred in 1980, 1981 and 1982, respondent was a practicing dentist in Lighthouse Point, Florida. During this time period, he treated a number of patients, including Mary Bishop, Doris Jenkins, Susan Clunk, Evelyn Bateman, Gerrit Van Triest, Peter Yann and Aaron Freinhar. Their patient records have been received in evidence. According to the administrative complaint, all patients allegedly requested that respondent install a porcelain faced crown on their teeth, and that respondent thereafter actually installed a less expensive plastic (acrylic) crown without advising the patients. The patients in question were all participants in a dental insurance program although the records do not disclose which plan was in effect during a given year. As such, the patient fees were either paid wholly or in part by the insurance company. However, respondent is not charged with improperly billing the patient or company, or exploiting the patient for his financial gain. Finally, his competence is not in issue. In May, 1983 respondent sold his Lighthouse Point practice to Dr. Eli W. Gottlieb. Doctor Gottlieb retained all records of patients previously treated by Dr. Wollman. Since the purchase, Dr. Gottlieb has continued treating five of the named patients. Of the seven patients referred to in the administrative complaint, only three appeared at final hearing. In addition, a dental laboratory owner and several office personnel who once worked for Dr. Wollman testified, as did Dr. Gottlieb concerning his analysis of the patient records and subsequent examinations and treatment of the patients. By agreement of the parties, the affidavit and two letters (only one of which is dated) of Dr. Mark Behar were received in evidence. Doctor Behar is a dentist who was employed by DPR to examine five of the patients and determine what type of crown was in their mouths. For purposes of this proceeding, there are two types of facing on a crown that may be used by a dentist: porcelain and plastic (acrylic). A porcelain faced crown is more expensive and durable, and less susceptible to discoloration and deterioration. Conversely, a plastic crown is less expensive than a porcelain faced crown, is subject to deterioration and discoloration, and may "fall off" the tooth after a period of time. However, the use of an acrylic crown is an acceptable material for dentists to use. As might be expected, the type of metal used in a crown affects the fee charged by the dentist, hence the higher charge for a porcelain faced crown. Finally, it is not unusual for a dentist to change his plan of treatment of a patient after studying models and performing other preparatory work. Count I - Mary Bishop Bishop first visited respondent's office around nine years ago. She selected Dr. Wollman since he was an approved provider for her dental insurance plan. In late 1979 or early 1980, Dr. Wollman recommended she have a splint with a crown placed on teeth numbers 18 and 19. She specifically requested a porcelain faced crown. She did so because she knew that plastic was not as good a material as porcelain. Respondent agreed to install that type material and thereafter installed a crown on teeth 18 and 19 around February or March, 1980. He did not advise her that anything other than porcelain facing had been used. Patient records reflect that an acrylic faced crown was ordered for Bishop. In May, 1986 Bishop visited Dr. Gottlieb who found the crown installed by Dr. Wollman had "deteriorated" and was "discolored," and that Bishop had a gum problem around teeth 18 and 19. He also observed that the crown facing was plastic, and not porcelain. This finding was corroborated by Dr. Behar who found all crowns and bridgework in Bishop's mouth to be of "an acrylic veneer nature." Count II - Doris Jenkins Jenkins did not appear at final hearing. Her patient records reflect she first began visiting respondent in November, 1981. In February, 1982 Dr. Wollman ordered an acrylic crown and installed it a month later on Jenkins' tooth number 30. The use of this type of material was confirmed by Dr. Behar who examined Jenkins on a later undisclosed date. An examination of Jenkins' patient records also reflects that the use of a porcelain faced crown may have been discussed with Jenkins during one of her visits to respondent's office in late 1981. However, whether this discussion culminated in an agreement that respondent provide such a crown on tooth 30 is not of record. Count III - Susan Clunk This patient also failed to testify at final hearing. Clunk's patient records reflected that a three unit fixed bridge with crowns was installed by respondent on teeth numbers 29, 30 and 31 in January, 1982. The patient charts do not indicate whether the crown facing was porcelain or plastic. However, billing records and an office assistant's testimony tend to show that Clunk was billed for a porcelain faced crown. An examination by Dr. Behar some years later reflected Clunk had no porcelain faced crowns in her mouth. There is no evidence as to whether this work was in accordance with what the patient had requested. Count IV - Evelyn Bateman Bateman did not appear as a witness in this proceeding. Her patient records reflect she had a three-unit fixed bridge with a crown installed by respondent in January, 1981 on teeth numbers 13, 14 and 15. However, the records do not show what type of crown was installed in Bateman's mouth. After reviewing the patient records, an office assistant believed the charges in Bateman's billing record were for porcelain faced material. Even so, there is no evidence as to what type of crown Bateman requested when she initially visited Dr. Wollman, or any subsequent representations by respondent. In 1985 Bateman visited Dr. Gottlieb who found she had an ulcer on the buccal side of her cheek. This was caused by the crowns "eating" her cheek. Gottlieb then observed that the crown was plastic, had "worn off," was discolored, and was "breaking apart." The presence of a plastic crown was also confirmed by Dr. Behar in an examination performed around January, 1985. Count V - Gerrit Van Triest Van Triest first used the services of Dr. Wollman in the late 1970s. He was insured under the then-applicable Denti-Care insurance plan. In March, 1980 Dr. Wollman installed a six-unit bridge with acrylic faced crowns on the patient's teeth numbers 22 through 27. According to Van Triest, he did not advise Dr. Wollman of the type of crown facing that he desired, nor was this matter ever discussed. In May, 1983 Dr. Gottlieb had an occasion to clean and examine Van Triest's teeth. At that time Gottlieb observed a fixed bridge with acrylic to veneer crowns on teeth 22 through 27, which was consistent with the work previously performed by Dr. Wollman some three years earlier. Count VI - Peter Yann Like several other patients, Yann was not a witness at final hearing. Yann's records indicate that a three-unit bridge with crowns was installed on teeth numbers 29, 30 and 31 in February, 1982. There is no evidence as to what type of crowns were requested by Yann, whether any representations were made by respondent, or whether the work performed was consistent with the parties' understanding. Count VII - Aaron Freinhar Freinhar was not present at final hearing. His records show that a three-unit splint with crowns was installed on teeth numbers 3, 4 and 5 by Dr. Wollman in December, 1981. The records also reflect that respondent ordered a plastic type facing on the crown. However, there is no evidence as to what type of crown, if any, Freinhar had requested, or whether subsequent representations were made by respondent. I. Miscellaneous In a letter dated March 27, 1986 from respondent to DPR counsel, Dr. Wollman expressed surprise over the charges and blamed any problems arising out of this proceeding with "laboratory deception." A laboratory owner denied this, and said all orders were filled in accordance with the dentist's order. The laboratory owner's testimony is deemed to be more credible and is hereby accepted. Respondent also acknowledged, by answer to interrogatory, that there was "no intentional misrepresentation to any patient," that the "use of acrylics was dentally justified in those patients and was based upon Dr. Wollman's judgment at the time," and that "any discrepancy in charges was either unintentional or done by other individuals without Dr. Wollman's knowledge." Jean Husarik was an employee of Dr. Wollman when the above events occurred. She stated that during the years in question Dr. Wollman had frequently charged patients for porcelain faced crowns and later installed the less expensive plastic faced crowns. Husarik also recalled a conversation with respondent at his home when he acknowledged doing so for financial gain. This testimony is found to be credible and is hereby accepted. A probable cause panel on this matter was convened on October 18, 1985. The transcript of hearing of that meeting reflects three Board members were present and voted to find probable cause against respondent. The discussion by the panel members reads as follows: DR. SINGLEDECKER: All right. I would like to proceed to the next case: Arthur Wollman, 0055693 and 52335. This is a case where there were seven Counts involving the subject making acrylic to metal crowns where the patient was informed that they were going to be getting porcelain fused to metal crowns. And the charges: The dentist is no longer in that practice, and he sold his practice. And the subsequent treating dentist -- Apparently, these patients had come into the office, and all of them had reported that they were of the understanding that their crown was to be porcelain fused to metal. And I believe it was six of the patients, either six or seven -- How many Counts were there? DR. FERRIS: Seven. DR. SINGLEDECKER: The last Count was repeated. Yes. There were seven patients, and all of these have the same thing reported. And that would constitute a violation of 4660281L by making deceptive, untrue or fraudulent misrepresentations in the practice of dentistry; and, 4660281U by being guilty of fraud, deceit or misconduct in the practice of dentistry. Some comments on the case: Some of the subjects couldn't be reached but there were at least three or four instances in here where the subjects could be reached. And a consultant did take a look at the case and verify that indeed the case was acrylic to metal. And the subsequent treating dentist said that. And all those patients, even in the records it was written down, porcelain to metal. But on the laboratory work authorizations, which were included, acrylic to metal was requested. DR. FERRIS: I am going to move finding a probable cause on the eight Count Administrative Complaint before us, namely, Case Numbers 55693 and 52335. DR. SINGLEDECKER: I'll second. It just seems that with the number of times that this was repeated, that there wasn't just a single instance of a mistake where something was written in the record and then in the laboratory something else happened. It seems that by the repeated number of times that this was done, that it seemed to be an intentional thing that was done. DR. FERRIS: You also have the testimony of the dental hygienist and the office manager that supports that the laboratory work orders and the implication throughout the investigative report that this is a pattern with the individual, consistent with the statement that was made in the investigative report, that many of the patients were in a certain dental plan in which fillings came free. And so he tended to defer smaller dentistry until it got to the point where it would be crowns, it would be bridge work, and therefore, would be compensated back. He would be compensated back. It was a consistent pattern of fraudulent activity in pursuit of his practice. MR. GREENE: Call the question. DR. SINGLEDECKER: All those in favor of finding probable cause on the eight Count Administrative Complaint signify by saying aye. THE PANEL: Aye. DR. SINGLEDECKER: Those opposed? THE PANEL: (No response.) DR. SINGLEDECKER: I would like to move that we file an Administrative Complaint on those charges. THE PANEL: Second. MR. GREENE: Third. DR. SINGLEDECKER: Is there any other discussion? DR. FERRIS: I would get in the form of discussion just because we are not going to discuss penalties unless they jump out at us. I would like to ask Ms. Gallagher what she thinks she would go for in a case like this. MS. GALLAGHER: I would think a minimum of three months' suspension. If it bears out the way we've alleged it, that it was fraudulent or was a mistake or some misunderstanding, then I would think a minimum of three months' suspension and a fine comparable to our costs or up to the maximum allowed by law. DR. FERRIS: Right on. DR. SINGLEDECKER: All those in favor of filing an Administrative Complaint signify by saying aye. THE PANEL: Aye. DR. SINGLEDECKER: Opposed? THE PANEL: (No response.) After probable cause was determined, an adminis- trative complaint was filed on November 20, 1985, and served on respondent. The complaint embodied the panel's action. The complaint was eventually forwarded to the Division of Administrative Hearings on December 23, 1986. Although not altogether clear, the delay in forwarding the case to the Division was caused by the efforts of the parties to reach an amicable settlement. By notice of hearing initially issued on January 26, 1987, the final hearing was scheduled for May 5, 6 and 7, 1987. By two motions to dismiss filed on April 23, 1987 respondent raised for the first time alleged irregularities in the probable cause and investigative phases of this proceeding. During the course of the hearing itself, additional alleged irregularities in the process were raised as grounds for dismissing this action.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that respondent be found guilty as to Count I and that all other charges be dismissed. Respondent should be assessed a $2,000 fine and his license should be suspended for thirty days. DONE AND ORDERED this 25th day of September, 1987, in Tallahassee, Leon County, Florida. DONALD R. ALEXANDER Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904)488-9675 Filed with the Clerk of the Division of Administrative Hearings this 25th day of September, 1987.
Findings Of Fact The Respondent, at all times material hereto, has been a dentist licensed in the State of Florida, holding license number DN 0005029. He is engaged in the practice of dentistry in Pensacola, specializing in orthodontics. The Petitioner is an agency of the State of Florida charged with regulating the licensure status, admission to practice and practice standards in the State of Florida. During the period from September 1980 until July 1981, Ms. Wendy Ling became a patient of the Respondent and went to the Respondent's office on a number of occasions during that period of time to receive dental treatment. During the course of her dental treatment involving installation, fitting and maintenance of braces, she became somewhat dissatisfied with the Respondent's services, claiming that he should have spent more time personally with her when she was in his office. Because of her dissatisfaction, she sought the services of another orthodontist, Dr. Trum. When she left the care of Dr. Tarwick and sought the services of Dr. Trum, she owed Dr. Tarwick $140 for services already rendered her for dental care. When Dr. Trum assumed responsibility for her care, he informed her that he would need copies of her dental records. Shortly thereafter, either Dr. Trum, a person in his office or Ms. Ling called Dr. Tarwick's office to seek the records. Dr. Tarwick's financial secretary responded that $140 was still owed on her bill from Dr. Tarwick. Dr. Tarwick refused to forward her records until her bill was paid. She continued to refuse to pay her outstanding bill and the doctor filed a civil action against her in county court and prevailed. The court found that she owed the sum in question but the Respondent accorded she and her husband, a doctor, "professional courtesy" and agreed to discharge the debt for the sum of $80. During the time when he had refused to forward her records prior to her paying her outstanding bill, she complained to the Petitioner regarding this situation. A representative of the Department of Professional Regulation contacted the Respondent and informed him of the legal requirement that he forward records regardless of whether an outstanding bill was due. The Respondent professed ignorance of that provision of the law, was apologetic and hastened to forward her records contending, as he did at the hearing, that he was unaware that it was illegal to withhold forwarding of the dental records pending payment of an outstanding bill for services rendered. Upon forwarding the record to Ms. Ling's new orthodontist, the Respondent charged her a duplication fee of $50 for this service. This resulted in the other count in the Administrative Complaint regarding the reasonableness of the $50 fee for duplication and forwarding of records. The Respondent established without question at the hearing that it cost in excess of $110 to duplicate such records, excluding the Respondent's own time involved. The records are not merely paper reports that must be xeroxed, they include molds and casts of the complaining witness' mouth and/or gums and teeth. Duplication of all these portions of her records is necessary because the professional association, to which the Respondent must belong, requires that he keep a complete set of records for all patients. It was thus unequivocally established that the Respondent's fee for this duplication and record forwarding was less than half of what it actually cost his office to perform. The Respondent quite candidly expressed to the Department of Professional Regulation his ignorance of the legal provision that he not withhold forwarding of records pending payment of outstanding fees and clearly informed the Department, before the Administrative Complaint was ever filed, that he did not dispute that allegation and that he would move quickly to correct the mistake, which he did. Thus, the Respondent went to the hearing in the belief that the only dispute with the Petitioner was the question of the reasonableness of the duplication and forwarding fee for the records. The Petitioner was on notice that the Respondent did not dispute the charge in Count I. At the hearing, however, the Petitioner voluntarily dismissed the count concerning the question of the reasonableness of the duplication and forwarding fee (paragraphs 12 and 13 of Count II of the Administrative Complaint). It is thus obvious that the only true dispute concerning which the hearing was convened was the question of the reasonableness of the duplication and forwarding fee since the department was already aware that the Respondent did not contest Count I concerning the issue of withholding the transfer of patient records pending payment of outstanding fees for services rendered. The Petitioner, however, did not voluntarily dismiss Count II and thus obviate the necessity of a hearing even though it was informed of Respondent's basis for the fee and the necessity for a large expenditure to bring in Witness Benz, who established its reasonableness, and even though it arrived at the decision to dismiss the charge in Count II some days prior to hearing. Therefore, believing that the department was proceeding against him in good faith on the question of reasonableness of the duplication fee, the Respondent hired an accountant to do a cost study of such duplication efforts by his office, whereupon aimed at a figure in excess of $110 for the performance of that service. The Respondent thus expended a substantial amount of money ($1,000) in paying the expert witness to prepare for, attend and testify at the hearing and was not informed by the department that it had chosen prior to the hearing to voluntarily dismiss that count until the convening of the hearing with the previously necessary witness already present. Both the testimony of Dr. Tarwick and the President of the Florida Association of Orthodontists established that it is customary in the profession to withhold duplication and transference of patient records until all fees have been paid and both expressed surprise that this might be illegal. Letters from other orthodontists in other cities were admitted by agreement establishing that this is indeed customary in the profession and not merely an isolated example of aberrant behavior by Dr. Tarwick. Further, it was established by Dr. Tarwick that, given that Ms. Ling's treatment contract ran through October 1982, the slight delay caused in transferring her records to her new doctor, Dr. Trum, caused no adverse effects on her course of treatment and the correction of her dental problem. Dr. Tarwick was unaware that he was violating the statute under which he was charged and did not intentionally do so. In all his conversations with counsel for the department, Mr. Carpino, the only dispute discussed between them concerned the $50 fee. It was the Respondent's belief that he had fully and early informed the department that he did not dispute the charge concerning the withholding of dental records in return for the payment of the outstanding fee.
Recommendation Having considered the foregoing Findings of Fact, Conclusions of Law, the candor and demeanor of the witnesses and the evidence in the record, it is, therefore RECOMMENDED: That, in view of the technical, isolated and inadvertent violation of the above authority by the Respondent, which he corrected as soon as he became aware of the violation, a minimal penalty consisting of a private written reprimand should be imposed. DONE and ENTERED this 29th day of December, 1982, in Tallahassee, Florida. P. MICHAEL RUFF 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 December, 1982. COPIES FURNISHED: Theodore R. Gay, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Salvatore A. Carpino, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 H. Edward Moore, Jr., Esquire Sherrill, Moore and Hill Post Office Box 1792 Pensacola, Florida 32598 Fred Varn, Executive Director Board of Dentistry Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Samuel R. Shorstein, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
Findings Of Fact The Parties stipulated to the fact that Dr. Moore was a dentist, licensed by the State Board, holding license number 1464, issued by the State Board. The Parties further stipulated that the facts alleged in the Board's complaint were accurate as of the date of filing. Dr. Ackel testified concerning professional practices. It is a part of the professional services of a dentist to fill out forms necessary for insurance coverage, although they may charge a fee for the time required to do so. The time required to fill out such forms, which are in the main prepared by clerical personnel in the dentist's office, varies from fifteen to forty-five minutes, to include the dentist's time taken to review the entries. The failure to prepare the forms results in nonpayment or delayed payment of insurance claims to the patient. Dr. Moore had delayed over a year the preparation and submission of the forms on the patients involved in this complaint. Dr. Ackel said this was the first such complaint that the Broward County Dental Association has had in his eight-year association with the Association's board which investigates patient complaints. Dr. Moore, having been cautioned about his rights in this case, took the stand and testified that he had had multiple personal problems beginning in 1973. These problems included within a two-year period a personal bankruptcy, a son who flunked out of medical school at the halfway point and subsequently was critically ill with ulcers, another son who suffered a mental depression which resulted in his hospitalization, a reduction in his office staff, and a separation from his wife who also worked in his office. While Dr. Moore acknowledged his ultimate responsibility for the failure to process the insurance forms involved, he did request the Board to consider the foregoing facts in mitigation. Dr. Moore's office is currently a one-man office with one receptionist who has been with the Doctor for twenty-two (22) years. There has been an increase recently in dental insurance claims; and Dr. Moore, who is an older dentist who had a good professional reputation in the community until these incidents, has apparently not adjusted his office administration to keep pace with the changes. This, together with his various personal problems, prevented him from attending to these important matters. Dr. Ackel stated that Dr. Moore had been suspended from the County Association for ninety (90) days as a result of its investigation and findings; however, that this suspension did not cause Dr. Moore to submit the forms. Dr. Moore apologized to all the parties concerned, indicated that he was acting immediately to hire additional personnel in his office, and that all the insurance forms in his office would be filled out and submitted immediately. The Hearing Officer notes, however, that the statements of Dr. Moore's patients indicate he had made similar assurances to his patients.
Recommendation The Dental Board's interest in this case is apparently twofold: To rectify the existing situation and enable Dr. Moore's patients to obtain reimbursement, and To prevent any further failures of this type by Dr. Moore. The Hearing Officer would recommend the following Board action based upon the Findings of Fact and Conclusions of Law: Dr. Moore's license be suspended for three to six months, said suspension or a portion thereof to be held in abeyance or suspended upon Dr. Moore's doing the following: Immediately filing the insurance forms involved here, with copies to the Board, and Permitting and reimbursing, if necessary, a representative or designee of the Dental Board with a reputation for effective office management within the profession to inspect Dr. Moore's office and make a written report to Dr. Moore and the Board suggested ways of improving his office management to prevent a recurrence of this type of failure. DONE and ORDERED this 4th day of September, 1976 in Tallahassee, Florida. STEPHEN F. DEAN, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: L. Haldane Taylor, Esquire 605 Florida Theatre Building 128 East Forsyth Street Jacksonville, Florida 32202 Castles W. Moore, D.D.S. 852 N. E. 20th Avenue Fort Lauderdale, Florida 33304
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 The issue to be resolved in this proceeding concerns whether disciplinary action should be imposed against the licensure of Douglas R. Shanklin, M.D., the Respondent, for allegedly falsely testifying that he had not been issued a "Letter of Guidance", in violation of Section 458.331(1)(k), Florida Statutes.
Findings Of Fact At all times material hereto, the Respondent was a physician licensed in the State of Florida. He holds license number ME0009372. The Petitioner is an agency of the State of Florida charged with regulating the licensure status and related practice standards of physicians in Florida, including making investigations and bringing Administrative Complaints against those physicians, in their licensure status, believed to be departing from those practice standards. On January 8, 1993, the Respondent testified as a defense witness, by deposition, in a medical malpractice case. The case style was Faircloth v. Coastal Empire Pathology Services, P.C., et al. The trial occurred in Savannah, Georgia. During his deposition, the Respondent was asked three times, by opposing counsel, if he had ever been issued a Letter of Guidance by any state licensing agency. The Respondent stated three times that, indeed, he had not. In fact, on May 15, 1984, a Probable Cause Panel of the Board of Medical Examiners in Florida considered a complaint against the Respondent. The Probable Cause Panel made a determination that while probable cause existed to believe that the Respondent had violated the provisions of the Medical Practice Act, the complaint should be dismissed with a Letter of Guidance. The Board stated in its Order that: Probable cause exists to believe that subject has violated the provisions of the Medical Practice Act. In light of the circumstances presented, however, this case should be and the same is hereby dismissed with a letter of guidance to subject. Thereafter, an undated letter was sent to and received by the Respondent. See Petitioner's Exhibit 2 in evidence. The Closing Order was never mailed to, nor received, by the Respondent. The Respondent was unaware of the Closing Order until March of 1993, when the investigation in this case was commenced and at which time he was first supplied a copy of that Closing Order of the Board's Probable Cause Panel. The Petitioner's Exhibit 2 in evidence, the undated letter, is not entitled or otherwise delineated as a "Letter of Guidance" and at no place in the letter is the word "guide" or "guidance" used. Consequently, at the time the Respondent received the letter, which is Exhibit 2, he did not understand or perceive it to be a Letter of Guidance but, rather, understood it to be a letter of closing indicating that he had prevailed in the complaint case. On January 8, 1993, when the Respondent testified at the deposition referenced above, he did not have in mind, nor did he remember, the undated letter. On January 8, 1993, when he testified at that deposition that he had not been issued the Letter of Guidance, he believed he was answering those questions truthfully. He did not know or understand that he had been issued a Letter of Guidance. On January 8, 1993, when he testified at the deposition, he did not testify falsely, because he had not been given the Closing Order at the time that the undated letter (Exhibit 2) was received. He thus did not understand that undated letter to be a Letter of Guidance from the then Department of Professional Regulation. He was never served a copy of the actual Closing Order which might have explained the situation to him. Consequently, he had a genuine, good-faith belief that he had not been issued a Letter of Guidance. Because his belief was genuine and he had no specific intent to tell a false story in those particulars, he made no false or fraudulent representation and committed no deception in conjunction with his answers to those questions at his deposition.
Recommendation Having considered the foregoing Findings of Fact, Conclusions of Law, the evidence or record, the candor and credibility of the witnesses, it is RECOMMENDED that a Final Order be entered finding the Respondent not guilty of violating Section 458.331(1)(k), Florida Statutes, and that the Complaint be dismissed in its entirely. DONE AND ENTERED this 3rd day of May, 1995, in Tallahassee, Florida. P. MICHAEL RUFF, 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 3rd day of May, 1995. APPENDIX TO RECOMMENDED ORDER, CASE NO. 94-5903 Petitioner's Proposed Findings of Fact 1-3. Accepted. 4-6. Rejected, as not entirely in accord with the greater weight of the evidence and as subordinate to the Hearing Officer's findings of fact on this subject matter. Respondent's Proposed Findings of Fact 1-11. Accepted. COPIES FURNISHED: Steven Rothenburg, Senior Attorney Agency for Health Care Administration 9125 Bay Plaza Boulevard Suite 210 Tampa, FL 33619 Larry G. Turner, Esquire Post Office Box 508 Gainesville, FL 32602 Dr. Marm Harris Executive Director Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-0792 Tom Wallace, Assistant Director Agency for Health Care Administration The Atrium, Suite 301 325 John Knox Road Tallahassee, FL 32303
Findings Of Fact The Respondent is licensed by the Petitioner to practice medicine in the State of Florida. The Respondent is a native of Cuba. He has been licensed as a physician in Florida since 1975, and has been practicing since then in Dade County. The Respondent has not been subject to any prior disciplinary action. Antonio Martos is a resident of Miami Beach. He is a native of Cuba, and does not speak English well. He testified at the hearing through an interpreter. Antonio Martos was a patient of the Respondent during 1976, 1977, 1978 and 1979. Among his complaints were that he had trouble sleeping. Antonio Martos did not see the Respondent at the Respondent's office, but rather saw him at his neighbor's house. Beginning in September, 1976, and once each month thereafter, through May, 1979, the Respondent issued prescriptions for forty- five 300 milligram Quaalude tablets for Antonio Rosario. Three specific prescriptions for these drugs were received into evidence, and the Respondent's medical records reflect the additional prescriptions. Quaalude is a brand name for Methaqualone, a "Schedule II" controlled substance under Section 893.03(2), Florida Statutes. Quaalude tends to induce dependency and tolerance. Long-term use of it is inappropriate because of the prospects for abuse. Prescriptions for Quaalude in the quantities and over the period of time for which they were prescribed by the Respondent for Antonio Martos are not in accord with community standards in Dade County, Florida, and are inappropriate and excessive and not in the best interest of the patient. The prescriptions are excessive to such a degree that they could not have been issued in good faith by the Respondent. The Respondent's records respecting Antonio Martos reflect that the Respondent saw him as a patient each month from September, 1976, through May, 1979. With the exception of five of the visits, the records reflect that all of them occurred on the first day of the month. Nearly all of the entries respecting Antonio Martos relate that he complained of insomnia and that his blood pressure was 120/80 and that his pulse rate was 80. It is not medically possible that an individual's pulse rate and blood pressure readings would be identical over such a long period of time on so many occasions. The Respondent fabricated these records to reflect visits that did not occur as indicated in the records. While no evidence was offered to establish with any definitiveness the purpose of the fabrications, it is apparent that the Respondent had a motivation to fabricate his records to reflect proper visits and prescriptions to the patient. Antonio Rosario and his wife testified that he had not been a patient of the Respondent's. This testimony has not been credited. The Martoses' testimony was false with respect to the nature of their relationship with their neighbor, in whose home they visited the Respondent. They were both actually seen to visit the Respondent in a patient relationship at their neighbor's home. It does not appear that the Martoses fabricated their testimony for any malicious reason. They were confronted by police, they clearly did not understand the nature of the confrontation, and it is logical to assume that they were fearful, and that they sought to absolve themselves from any difficulties. Rosario Martos is a resident of Miami Beach, and a native of Cuba. She is married to Antonio Martos. Rosario Martos does not speak English well, and she testified at the hearing through a translator. Rosario Martos was a patient of the Respondent during 1977, 1978, and 1979. She complained primarily of insomnia and high blood pressure. She did not visit the Respondent in his office, but rather saw him at her neighbor's house. Commencing in January, 1977, and each month thereafter through August, 1979, the Respondent issued prescriptions for forty-five 300 milligram Quaalude tablets for Rosario Martos. Eight of these prescriptions were received into evidence at the final hearing, and the remainder are reflected in the Respondent's medical records. Prescriptions for Quaalude in these quantities over this period of time is not in accord with community standards in Dade County, Florida. Such prescriptions are inappropriate and excessive, and not in the best interest of the patient. The prescriptions are so excessive as not to have been issued in good faith. The Respondent's records reflecting Rosario Martos reflect that he visited her once each month from January, 1977, through January, 1979. With a few exceptions, the records reflect that he visited her on the first day of each month. The records reflect that her complaint was always the same, high blood pressure and insomnia. Except for a few occasions, her blood pressure and pulse were 120/80 and 80, respectively. These records were fabricated. It is not medically possible that a patient's pulse and blood pressure could be so consistent on so many occasions over such a long period of time. It is apparent that the records were developed in order to reflect visits which either did not occur, or did not occur in the manner reflected in the records. Rosario Martos testified that she was never a patient of the Respondent, and that she did not receive the prescriptions. Her testimony has not been credited for the reasons set out in paragraph 2 above. Enrique Nebot was a patient of the Respondent's during 1976 through 1979. The Respondent issued prescriptions for forty-five 300 milligram Quaalude tablets to Enrique Nebot once each month beginning in October, 1976, and continuing through June, 1979. Four of these prescriptions were received into evidence at the final hearing, and the rest are reflected in the Respondent's medical records. The Respondent's records reflect only that Enrique Nebot complained of insomnia. Prescriptions of Quaalude in these quantities over this period of time are not in accord with community standards in Dade County, Florida. Such prescriptions are inappropriate and excessive and not in the best interest of the patient. The prescriptions are so excessive that they could not have been issued in good faith. The Respondent's records reflect that Enrique Nebot visited him generally on the fifteenth day of each month beginning in October, 1976, and continuing through June, 1979. The records reflect the same complaints, and a pulse rate of 80 and a blood pressure of 120/80 on each visit. It is not possible that a patient could have the same pulse and blood pressure readings on so many occasions over such a long period of time. The records were fabricated to reflect visits either that did not occur, or that did not occur in the manner described in the records. Gerardo Montes was a patient of the Respondent during 1977 through 1979. The Respondent's records reflect that Gerardo Montes complained of insomnia. Once each month beginning in September, 1977, and continuing through August, 1979, the Respondent issued a prescription to Gerardo Montes for forty- five 300 milligram Quaalude tablets. Seven of these prescriptions were received into evidence at the final hearing. The remainder of them are reflected in the Respondent's medical records. Prescriptions for Quaaludes in these quantities over this period of time are not in accord with community standards in Dade County, Florida. The prescriptions are inappropriate and excessive, and not in the best interest of the patient. The prescriptions are so excessive that they could not have been issued in good faith. The Respondent falsified medical records respecting Gerardo Montes. Records were created to reflect visits once each month commencing in September, 1977, and continuing through August, 1979. The records were written all at one time, rather than in response to individual appointments or visits. Lidia Tabio is a resident of Dade County, Florida, and a native of Cuba. She was a patient of the Respondent during 1976 through 1979. Her complaints were generally hypertension and insomnia. She visited the Respondent either in his office or at home in response to her symptoms. Once each month commencing in September, 1976, and continuing through July, 1979, the Respondent issued prescriptions for forty-five 300 milligram Quaalude tablets to Lidia Tabio. Five of these prescriptions were received into evidence at the final hearing, and the remainder are reflected in the Respondent's records. Prescriptions for Quaaludes in these quantities over this period of time are not in accord with community standards in Dade County, Florida. The prescriptions are inappropriate and excessive and not in the best interest of the patient. The prescriptions are so excessive that they could not have been issued in good faith. The Respondent's records respecting Lidia Tabio reflect that he saw her once each month commencing in September, 1976, and continuing through July, 1979. The visits are reflected to be on the second day of each month. On each occasion the patient's blood pressure reading was related as 120/80, and her pulse reading was reflected, commencing at least in May, 1977, as 77. It is not possible that a patient would reflect such constant blood pressure and pulse readings over such a long period of time. The patient herself testified that she visited the Respondent only in response to symptoms, and not on the second day of each month as reflected in the records. The Respondent fabricated Lidia Tabio's records. Juan Morales Tabio is a resident of Dade County, Florida, and a native of Cuba. Juan Tabio was a patient of the Respondent during 1976 through 1979. His complaints were generally hypertension and insomnia. He visited the Respondent generally in the Respondent's office. The Respondent issued prescriptions for forty-five 300 milligram Quaalude tablets for Juan Tabio once each month commencing in September, 1976, and continuing through August, 1979. One of these prescriptions was received into evidence at the hearing, and the remainder are determined from the Respondent's records. Prescriptions for Quaaludes in these quantities over this period of time are not in accord with community standards in Dade County, Florida. The prescriptions are inappropriate and excessive and not in the best interest of the patient. The prescriptions are so excessive that they could not have been issued in good faith. The Respondent's records respecting Juan Tabio reflect that he visited the Respondent once each month commencing in September, 1976, and continuing through August, 1979. On each occasion the patient's pulse is indicated as having been 80, and blood pressure as 120/80. Such consistent blood pressure and pulse readings over such a long period of time are not possible. These portions of the records are fabricated. Ramon Gonzalez is a resident of Dade County, Florida. He was a patient of the Respondent's during 1976 through 1979. His complaints generally were nervousness and that he could not sleep well. Once each month commencing in March, 1976, and continuing through July, 1979, the Respondent issued prescriptions for forty-five 300 milligram Quaalude tablets for Ramon Gonzalez. One of the prescriptions was received into evidence at the hearing, and the remainder are reflected in the Respondent's medical records. Prescriptions for Quaalude in these quantities over this period of time are not in accord with community standards in Dade County, Florida. The prescriptions are inappropriate and excessive and not in the best interest of the patient. The prescriptions are so excessive that they could not have been issued in good faith. The evidence does not establish that the Respondent's records respecting Ramon Gonzalez were fabricated. Counts XXIX through XXXII of the Administrative Complaint relate to Susan Waxman, an alleged patient of the Respondent. The evidence does not establish that inappropriate prescriptions were issued to Susan Waxman nor that her medical records were in any way fabricated or altered. Counts XXXIII through XXXVI of the Administrative Complaint relate to a person named Lueinea Gonzalez. No evidence was offered with respect to the allegations set out in Counts XXXIII through XXXVI of the Complaint. There was no evidence from which it could be concluded that any of the prescriptions for Quaalude that the Respondent issued were used either by himself, or by persons other than those for whom the prescriptions were issued.
Recommendation Based upon the foregoing findings of fact and conclusions of law, it is, hereby, RECOMMENDED: That the Board of Medical Examiners enter a final order finding the Respondent guilty of the charges enumerated in paragraphs 2, 3 and 4 of the Conclusions of Law above; suspending the Respondent's license to practice as a physician in the State of Florida for a period of two years; imposing an administrative fine against the Respondent in the amount of $2,000; and permanently restricting the Respondent's practice so that after the period of his suspension, the Respondent is not permitted to prescribe, dispense, administer, mix, or otherwise prepare any controlled substance. That the Board of Medical Examiners enter a final order dismissing Counts IV, VIII, XII, XVI, XX, XXIV, and XXVII through XXXVI of the Amended Administrative Complaint. RECOMMENDED this day of April, 1981, in Tallahassee, Florida. G. STEVEN PFEIFFER Assistant Director 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 day of April, 1981. COPIES FURNISHED: Deborah J. Miller, Esquire Assistant General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Maurice M. Diliberto, Esquire Suite 800, Ainsley Building 14 Northeast First Avenue Miami, Florida 33132 Ms. Nancy Kelley Wittenberg, Secretary Department of professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 ================================================================= AGENCY FINAL ORDER ================================================================= BEFORE THE BOARD OF MEDICAL EXAMINERS DEPARTMENT OF PROFESSIONAL REGULATION, Petitioner, vs. CASE NO. 81-192 RUSQUIN DUANY GONZALEZ, M. D., Respondent. /
The Issue Whether Respondent committed the violations alleged in the Administrative Complaint. If so, what punitive action should be taken against Respondent.
Findings Of Fact Based upon the evidence adduced at hearing and the record as a whole, the following findings of fact are made: Petitioner is a state government licensing and regulatory agency. Respondent is now, and has been since August 5, 1981, a dentist licensed to practice dentistry in the State of Florida. His license number is DN 0009016. In 1982, Respondent formed Dade Family Dental Facilities, Inc. (DFDF), a multidentist, multioffice dental practice in Dade County. He and Todd Smith, D.M.D., are currently co-owners of DDF. At all times material to the instant case, C.A., who is presently 40 years of age, was a patient at DFDF under the primary care of Respondent. C.A. was not just a patient of Respondent's. He was also someone whom Respondent considered to be a friend. Nonetheless, C.A. proved to be an uncooperative and difficult patient. It was not uncommon for C.A. to miss scheduled appointments. Oftentimes, C.A. would show up at one of DFDF's three Miami offices without an appointment claiming that he had a dental emergency and needed to be seen. Whenever his schedule permitted, Respondent accommodated C.A. and provided him with treatment, even though C.A. did not have a scheduled appointment. C.A. failed to take proper care of his teeth and gums. Furthermore, he was a heavy smoker. (Smoking can exacerbate periodontal problems.) By Respondent's own admission (made at the final hearing in this case), he "could have been a lot more extensive in [the] notes [he maintained on C.A.], but because [C.A.] was a friend, he . . . neglected to [provide such additional detail.]" His handwritten notes (and those made by his assistants pursuant to his instructions and directives) concerning his care and treatment of C.A. are sketchy and incomplete.1 They do not provide sufficient information to give neutral third parties a reasonably clear understanding of the full extent of the services he provided C.A. and the circumstances that led him to follow such a course of treatment. C.A. first presented to Respondent on May 19, 1988. It was an emergency visit. C.A. complained to Respondent of pain in tooth number 18. Respondent began a root canal in an attempt to alleviate the pain C.A. was experiencing. Thereafter, full-mouth x-rays were taken, and a complete examination was given. Based upon his review of the x-rays and the results of his examination, Respondent devised a treatment plan for C.A., which he reduced to writing and included in C.A.'s chart. Respondent's written treatment plan did not contain any mention of tooth number 18. It was merely a partial listing of work that needed to be done on C.A. At no time did Respondent subsequently update, supplement or otherwise modify this written treatment plan. The root canal that Respondent began on May 19, 1988, was completed by him on or about May 29, 1988. C.A. next visited Respondent on June 15, 1988. He came in without an appointment complaining of pain in tooth number 21. Respondent performed root canal therapy on the tooth. Although Respondent had determined that C.A. had periodontal disease, he did not specifically so state in the dental records that he maintained on C.A. Respondent initially treated C.A.'s periodontal disease by having his dental hygienist, Glenda Garvin, perform root planning (scraping the roots below the gums) and curettage (detoxifying the root surfaces from plaque). These procedures were performed on December 13, 1988, and again on February 2, 1989. Root planning and curettage are generally accepted methods of initially treating periodontal disease. Respondent subsequently determined that C.A. required the services of a periodontal specialist. He therefore referred C.A. to Ronald Cohen, D.D.S. Dr. Cohen is a Florida-licensed dentist. At the time he had an arrangement with Respondent whereby he performed periodontal services for Respondent's patients at Respondent's Northwest 18th Avenue and 183rd Street (Miami) office. He performed these services, not under the direction or supervision of Respondent, but as an independent contractor. Respondent billed the patients (or their insurance companies) for the periodontal services Dr. Cohen performed and he paid Dr. Cohen a percentage of the fees he received. Dr. Cohen first saw C.A. on October 5, 1989. He confirmed Respondent's diagnosis of periodontal disease. Unlike Respondent, however, Dr. Cohen made mention of this diagnosis in the notes that he made concerning his care and treatment of C.A. and which he left with Respondent. Among the other things that he mentioned in his notes was that tooth number 3 "[m]ay need distal root application." Dr. Cohen determined that C.A. required osseous (referring to the bone supporting the teeth) surgery. 21, Dr. Cohen performed such surgery approximately one week after C.A.'s October 5, 1989, visit. Thereafter, Dr. Cohen referred C.A. back to Respondent for restorative procedures. Respondent saw C.A. on December 5, 1989. Respondent's notes of C.A.'s December 5, 1989, visit read simply as follows: "Bridge Prep. #s 3-6. Imp. for Temp." No other information is given. The pontics and abutments of the bridge referenced in the notes are not identified. Furthermore, the notes do not indicate, nor does a review of the other materials in the records maintained by Respondent reveal, any reason why a bridge was needed for teeth numbers 3 through 6. Respondent's records do not contain any x-rays or notations indicating that any of these teeth were missing at the time of C.A.'s December 5, 1989, visit. In March of 1990, after C.A.'s gums had healed sufficiently from the surgery Dr. Cohen had performed,2 Respondent prepared a bridge for C.A. for teeth numbers 18 through 30. He used bridge work made by Budget Labs. Respondent was not satisfied with the appearance or the fit of the bridge. He therefore told C.A., on March 27, 1990, that he would have the bridge replaced, at no cost to C.A. The replacement bridge was for teeth numbers 19 through 31 (rather than 18 through 30). It was made by Mel Simkins. Simkins has been a dental technician for the past 48 years. Respondent wanted to make absolutely sure that there were not any problems with the bridge, so he asked Simkins to be present when the bridge was fitted and tested. The bridge was put in on or about May 26, 1990. At the time, it fit well and C.A. had no complaints. The margins were adequately sealed.3 There were sufficient embrasure spaces. The abutment-to-pontic ratio was adequate. Respondent saw C.A. again on September 18, 1990. At the time the bridge (that he had put in on or about May 26, 1990) appeared to still be intact and fit well. C.A., however, complained of pain in the area of tooth number 27, one of the teeth used as an abutment for the bridge. (On a previous visit on March 24, 1990, Respondent had performed root canal therapy on this tooth.) Respondent consulted with Dr. Cohen about the matter. He asked Dr. Cohen "how efficient he was at doing an apicoectomy" (which involves removal of the root tip). Dr. Cohen indicated that he was capable of performing such a procedure. Respondent subsequently referred C.A. to Dr. Cohen to perform an apicoectomy on tooth number 27. Before seeing Dr. Cohen again, C.A. returned to the DFDF on September 25, 1990. On this visit, he was seen by Dr. Smith, who did composite restoration work on teeth numbers 6 and 11 (located on the upper arch).4 Although he performed work on the upper arch, Dr. Smith visually examined C.A.'s entire mouth, and he noticed the bridge on the lower arch. The bridge did not appear to be ill-fitted. Dr. Smith commented to C.A. that the bridge looked good. In response to this comment, C.A. indicated to Dr. Smith that he was pleased with the bridge. C.A. saw Dr. Cohen on January 3, 1991, at which time Dr. Cohen performed an apicoectomy on C.A.'s tooth number 27. Approximately a week later C.A. saw Respondent. For the first time, C.A. expressed to Respondent dissatisfaction with the aesthetics of C.A.'s lower bridge. Respondent examined C.A. He observed that "the tissue was resorbed, so that the gums pulled back from the bridge." Respondent told C.A. that he would replace the bridge at no cost to C.A. C.A. declined the offer stating that he "wanted to move on." He asked Respondent to give him back his money (that he paid Respondent for the lower bridge). Respondent refused. As he said he would, C.A. "moved on" to another dentist. On February 12, 1991, he went to see Frederick Knoll, D.D.S. Dr. Knoll examined C.A. He then discussed his findings and available treatment options with C.A. During the discussion, C.A. advised Dr. Knoll that he was not "going to do anything about [his condition]." C.A. left Dr. Knoll's office without receiving any treatment or making a return appointment. Several months later, Dr. Knoll was asked by attorneys that C.A. had retained to provide them with a written assessment of C.A.'s condition based upon his February 12, 1991, examination of C.A. In response, Dr. Knoll wrote the following letter, dated August 20, 1991, to C.A.'s attorneys, in which he described what his February 12, 1991, examination had revealed: [C.A.] presented himself to me for a complete dental examination on 2/12/91. His chief complaint was of pain in the lower right area, and a general discomfort. A full series of radiographs were taken by [C.A.'s] periodontist and were made available for me to examine. [C.A.] has class III periodontitis with the sequela of alveolar bone loss and tooth mobility. He has the additional problem of multiple endodontic problems, some of which may need to be solved by surgery. The existing restorative dentistry needs to be changed. It is currently contributing to the periodontal problem, and additional splinting will be necessary for stability. Extensive caries are also present. I have recommended to [C.A.] that his problem requires a multi-disciplined approach to achieve a satisfactory result. I asked him to continue with his periodontist and to get the necessary help from an endodontist. I would coordinate the treatment and do all the restorative dentistry. I have enclosed a proposed treatment plan with the current costs involved. This treatment plan does not include the cost and treatment Dr. August will incur from the periodontist or the endodontist. If you need any further information on this matter, please feel free to contact me. "[T]he existing restorative dentistry" to which Dr. Knoll referred in his letter was upper and lower crown and bridge work. Upon examining C.A. on February 12, 1991, Dr. Knoll had observed crowns with "wide open margins." On October 28, 1992, C.A. filed a malpractice lawsuit against Respondent alleging that Respondent had failed to properly diagnose his periodontal disease and, as a result, his crown and bridge work failed and he suffered bone loss. Respondent had never before, nor has he subsequently, been a defendant in a malpractice lawsuit. The lawsuit was settled on May 18, 1994. The settlement agreement provided for a payment of $55,000.00 to C.A. The payment was made on behalf of Respondent by his insurer. Upon being notified of the settlement, AHCA commenced an investigation to determine if the initiation of a disciplinary proceeding against Respondent was warranted. The AHCA investigator assigned the case, Kathy Redfearn, invited Respondent to submit a written statement for consideration. Respondent submitted such a statement. It read as follows: This case [C.A.] vs Webb was originally [C.A] vs Webb/Cohen. [C.A.'s] attorney later dropped Ron Cohen from the suit because, as I was told, they were unable to obtain a mailing address on Dr. Cohen and subsequently pursued me for vicarious liability. [C.A.] went through a regimental Perio program which included root planning/curettage and full mouth flap and osseous performed by Dr. Ron Cohen. After perio surgery a bridge #18-305 was completed on 6-26-90. [C.A.] was very pleased with the bridge and indicated so to the lab technician and his friend a periodontist. On 9-18-90, [C.A.] complained of pain on #27 and was referred to Dr. Cohen for a second opinion on a possible Apicoectomy on #27. Dr. Cohen performed [an] apicoectomy [on] #27, on 1-3-91, for [C.A.] and following this procedure [C.A.] complained of a "botched job" on the apicioectomy, #27, and dissatisfaction with the esthetics of the placed bridge. The bridge I placed was compromised after the apicoectomy procedure because of resorption in areas #25, 26, and 27 where the flap had been extended possibl[y] due to no buccal bone and extreme cyst. (see Dr. Cohen's notes.) Prior to the apicoectomy there w[ere] no signs of resorption under the bridge and no signs of a compromised or inferior bridge. This case went to mediation and both parties negotiated in certain areas including the fact that I was ultimately responsible for Dr. Cohen's work because I had employed him, hence vicarious liability. AHCA sought C.A.'s assistance in the investigation, but he refused to cooperate. He was asked to sign and return an Authorization for Release of Patient Information, but he failed to do so. After AHCA completed its investigation, the matter was presented to a probable cause panel. Thereafter, the Administrative Complaint which is the subject of the instant case was issued
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department issue a final order (1) dismissing Count I of the Administrative Complaint; (2) finding Respondent guilty of violating Section 466.028(1)(m), Florida Statutes, as alleged in Count II of the Administrative Complaint (except to the extent that Count II charges Respondent with violating Section 466.028(1)(m), Florida Statutes, by not keeping records "correctly indicat[ing] amounts owed to [him] in relation to amounts paid by Patient C.A.," which allegation should be dismissed); and (3) as punishment for Respondent's violation of Section 466.028(1)(m), Florida Statutes, issuing him a reprimand, fining him $1,000.00, and placing him on probation for a period of one year subject to such conditions as the Board may specify. DONE AND ENTERED this 31st day of October, 1997, in Tallahassee, Leon County, Florida. STUART M. LERNER Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (904) 488-9675 SUNCOM 278-9675 Fax Filing (904) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 31st day of October, 1997.
Findings Of Fact At all times material hereto, Respondent was licensed to practice dentistry in the State of Florida, having been issued license number DN-0000975. Respondent has been licensed to practice dentistry in this State since 1944, and there is no evidence in the record to indicate that he has previously been the subject of a complaint, investigation or license disciplinary action. Respondent was a participant in the Medicaid program, at all times material hereto. He executed a provider agreement with the Department of Health and Rehabilitative Services, under the terms of which Medicaid paid a total of $300 for a set of upper and lower dentures, and he was allowed to bill the patient for a 5% co-payment in addition to the amount paid by Medicaid. Participants in the program specifically agreed to accept the Medicaid-payment in lieu of their usual and customary charges, and not to bill or accept payments from patients, with the sole exception of the 5% co-payment for dentures. Billings to Medicaid could only be made after services were rendered. The Medicaid program reimbursed providers $8.00 for a single surface amalgam restoration, $16.00 for two surfaces, and $24.00 for three of more surfaces. The maximum allowable fee under the Medicaid program for a complete upper set of dentures was $150.00, and for a complete lower set, $150.00. Alveolectomies were reimbursed at $35.00 per quadrant. Between November 4, 1983 and December 15, 1983, Respondent rendered dental services to Geraldine Jones, for which he subsequently billed, and was paid by, Medicaid. The billings were for extracting fifteen teeth, performing three alveolectomies, and fitting the patient with complete upper and lower dentures. Respondent did not perform any of these services for Jones. Therefore, the $423 paid to him by Medicaid was an overpayment, and a payment for services not performed. Respondent billed and was subsequently paid by Medicaid for dental services rendered to Velma Mondy between May 11, 1983 and June 16, 1983. The billings were for restoration of a total of eighteen tooth surfaces. On or about June, 1985, an examination of Mondy's teeth by Dr. Charles Kekich, dental consultant with the Department of Health and Rehabilitative Services, who was accepted as an expert in dentistry, revealed that she had a total of only six surfaces restored. Therefore, Respondent billed and received an overpayment from Medicaid in the amount of $96.00 for services not rendered to this patient. Dental services which were allegedly rendered to Bridget Bryant by Respondent between September 12 and 26, 1983, were billed to Medicaid, and Respondent received payment for restoring twelve teeth, with a total of thirty surfaces. On or about June, 1985, an examination of Bryant by Dr. Kekich revealed that no more than fifteen restorations had been performed, resulting in an overpayment from Medicaid to Respondent of at least $120.00. Respondent billed and was subsequently paid by Medicaid for services rendered to Joyce Johnson between December 22, 1983 and January 1, 1984. These billings were for extracting three teeth and restoring ten, with a total of twenty surfaces. During June, 1985, Dr. Kekich examined Johnson and found that none of the work billed by Respondent had been performed. Therefore, an overpayment of $184.00 was made by Medicaid for services billed, but not rendered by the Respondent. Between January 25, 1984 and March 21, 1984, Respondent performed certain dental work on Ernest Macon, for which he billed and was paid by Medicaid for extracting two teeth and restoring nine teeth, with a total of twenty-three surfaces. Dr. Kekich's examination of Macon during June, 1985, revealed that only one tooth had been extracted and no more than four surfaces had been restored. Therefore, Respondent over billed and received payment from Medicaid for services not rendered to Macon in the amount of $159.00 Respondent billed and was subsequently paid by Medicaid for dental services rendered to Derrick Ealy between March 15 and 27, 1984. These billings were for restoring four teeth, with a total of eleven surfaces. An examination of Derrick Ealy by Dr. Kekich in June, 1985, revealed that only two surfaces had been restored, resulting in an overpayment by Medicaid of $72.00 for services billed, but not rendered. An examination of Kimberly Ealy in June, 1985, revealed that none of the dental services for which Respondent had billed and been paid by Medicaid had, in fact, been performed. Respondent had billed Medicaid for extracting one tooth and restoring a total of thirteen surfaces on five teeth between March 13 and 22, 1984. Therefore, an overpayment of $114 was made by Medicaid for services billed, but not rendered to Kimberly Ealy. Respondent performed dental services for Corey Oliver between March 27, 1984 and May 6, 1984, and in connection therewith, he billed Medicaid for extracting one tooth and restoring seven teeth with a total of seventeen surfaces. An examination of Oliver by Dr. Kekich in June, 1985, revealed that roots of the tooth supposedly extracted by Respondent remained, and that eleven of the surfaces for which bills had been submitted had not been restored. Therefore, an overpayment of at least $95.00 was made by Medicaid for services billed, but not rendered to this patient. From April 16, 1984 to August 7, 1984, Respondent extracted twenty- seven teeth from Lillian Corouthers, and fitted her for a full set of dentures. He billed Medicaid for a total of $1,215 for these services, and received payment from Medicaid of $620.35. In addition thereto, he billed and received from this patient a total of $269. This co-payment exceeds the allowable 5% co- payment under the Medicaid program by $236.35. There is no evidence that Respondent ever refunded any portion of this overpayment to Corouthers. Although Respondent billed and was paid by Medicaid for services performed on Shawn Smith between July 11 and 24, 1984, which allegedly consisted of restoring eight teeth with a total of twenty-one surfaces, an examination of this patient by Dr. Kekich in May, 1985, revealed that none of this work had been performed. Therefore, an overpayment of $168 was made by Medicaid for services not rendered by Respondent. Respondent billed and was subsequently paid by Medicaid for dental services rendered to Allan Smith between July 6 and 23, 1984. The billings were for extracting two teeth and restoring a total of seventeen surfaces. Dr. Kekich's examination in May, 1985, revealed that only one extraction had been performed, and no restorations. As a result, an overpayment of $146 was made by Medicaid for services not rendered to Allan Smith. Respondent pulled one tooth and provided a complete set of dentures to Mose Tobias in July, 1984. For these services Respondent billed Medicaid for a total of $490, and received payment from Medicaid in the amount of $321.10. He also billed and received payment from this patient in the amount of $119, which exceeds the co-payment allowable under the Medicaid program by $112.11. Between July 6 and August 14, 1984, Respondent performed dental services for Angela Pleas, and in connection therewith, he billed and was subsequently paid by Medicaid for two extractions and sixteen surface restorations. During a June, 1985, examination of Pleas, it was revealed that no more than one extraction and nine restorations had been performed, resulting in an overpayment by Medicaid of $82.00 for services billed but not rendered to Pleas by the Respondent. Callie Wilson was treated by the Respondent between August 2 and 23, 1984, and in connection therewith, he billed Medicaid a total of $470.00 for an examination, x-rays, and a complete set of dentures. Respondent received payment from Medicaid in the amount of $162.45 for these services. In addition thereto, Respondent billed and received from Wilson an amount that exceeds the allowable 5% co-payment under the Medicaid program. The exact amount of this overpayment, however, cannot be determined, but it appears to have been an overpayment of between $45.00 and $95.00. Respondent billed and was subsequently paid by Medicaid for extracting one tooth and restoring twenty-two surfaces for Maruise Woods between September 4 and 25, 1984. An examination of Woods by Dr. Kekich in May, 1985, revealed that no surface restorations had been performed. Therefore, an overpayment of $172 was made by Medicaid for services not rendered. Between September 21 and 27, 1984, Respondent claims to have performed dental services for Sharon Woods, for which he then billed and subsequently received payment from Medicaid for the restoration of four teeth, with a total of twelve surfaces. In May, 1985, Dr. Kekich examined Sharon Woods, and found that none of this work had been performed. Therefore, Respondent overbilled Medicaid $96 for services not rendered to this patient. Respondent billed and was subsequently paid by Medicaid for dental services rendered to John Aberdeen between September 27 and November 21, 1984. These billings were for extracting fifteen teeth, and providing a complete set of dentures. A June, 1985 examination of this patient by Dr. Kekich revealed that only one tooth had been extracted. Respondent received an overpayment from Medicaid in the amount of $389.85 for services not rendered to Aberdeen. Bills were submitted to Medicaid and payment received for services Respondent claims to have performed on Mercedia Lanier between October 1 and 19, 1984. These billings were for restoring seven teeth, with a total of eighteen surfaces. Dr. Kekich's examination of Lanier in May, 1985, revealed that none of the work billed by Respondent had been performed. Therefore, an overpayment of $144.00 was made by Medicaid for services not rendered to Lanier by Respondent. Respondent billed and was subsequently paid by Medicaid for dental services rendered to Patricia Hall between November 20 and December 7, 1984. These billings were for seven extractions, and the restoration of five teeth with twelve surfaces. In June, 1985, Dr. Kekich examined Hall and found that no more than four extractions, and five surface restorations had been done. Medicaid made an overpayment of $83.00 in connection with services billed, but not rendered to Hall. Claims were submitted to Medicaid by Respondent in connection with services allegedly performed on Eugenie Perry between January 17 and February 11, 1985. These billing were for the restoration of twenty-two surfaces, but Dr. Kekich found in May, 1985, that none of these restorations had been performed. As a result, Medicaid made an overpayment to Respondent of $176.00 for services not rendered. Tessie McRae was a patient of Respondent's in 1985, and claims were filed with Medicaid by Respondent for services between February 5 and March 28, 1985, consisting of ten extractions, four alveolectomies, and a complete set of dentures. When Albert Ravenna, special agent for Medicaid fraud with the Auditor General's Office interviewed McRae in June, 1985, she still had her own teeth and did not have dentures. Respondent did provide her with dentures subsequent to payment for these services by Medicaid. However, an overpayment of $401.55 was made by Medicaid since the services for which billings were submitted by the Respondent had not been performed prior to the filing of these claims. Respondent billed Medicaid for a total of $600 in connection with services he provided to Cora Griffin between February 3 and 11, 1985. Specifically, these bills were for an exam, x-rays and a complete set of dentures. Medicaid paid Respondent $311.60 for these services, and in addition thereto, he billed and collected from Griffin a total of $180. This amount paid by the patient exceeds the allowable co-payment under the Medicaid program. Respondent billed and subsequently received payment from Medicaid for services rendered to Kenneth Gainer between January 25 and March 22, 1985. The billings were for restoring ten teeth with a total of twenty-six surfaces. An examination of Gainer by Dr. Kekich in June, 1985, revealed that none of this work had been performed. Therefore, an overpayment of $208.00 was made by Medicaid for services not rendered. Billings were submitted to Medicaid by Respondent for services allegedly performed on Lawrence Harvey between March 14 and 19, 1985, and consisting of two extractions and eight surface restorations. Dr. Kekich found, upon examining the patient in June, 1985, that none of this work had been performed. Therefore, an overpayment of $84.00 was made by Medicaid for services not rendered. Respondent billed and was subsequently paid by Medicaid for services rendered to Brian Harvey between March 13 and 29, 1985. These billings were for restoring six teeth with a total of twelve surfaces. Respondent did not perform these services, and, therefore, the payment of $96.00 which he received for these services from Medicaid represents an overpayment for services not rendered. According to billings submitted by Respondent to Medicaid, he treated Felicia Harvey between March 21 and 29, 1985. These billings were for restoring four teeth, with a total of eight surfaces. An examination of this patient by Dr. Kekich in June, 1985, revealed that none of this work had been performed, and, therefore, an overpayment of $64.00 was made by Medicaid for services not rendered. On or about December 19, 1986, Respondent plead nolo contendere to seventeen counts of grand theft and five felony counts of public assistance fraud in violation of Sections 812.014 and 409.325, Florida Statutes, and was adjudicated guilty. The billings that Respondent signed and submitted to Medicaid, which are referenced in the above findings of fact, were prepared by his office receptionist, Ida Roundtree, who has been employed by him for twenty-two years, and who is responsible for the preparation and filing of all insurance claims based upon patient dental charts prepared by Respondent or his dental hygienist. Respondent testified that he does not consider it to be his responsibility to familiarize himself with the various requirements for insurance or Medicaid reimbursement. He relies entirely on Roundtree for this, and clearly does not consider the preparation of reimbursement or billing "paperwork" to be within the practice of dentistry. Roundtree admitted that she prepared Medicaid billings for work which was yet to be done in some cases. She would just fill in dates when the work supposedly had been done so that Medicaid would pay the claim. She testified she was unaware that Medicaid allowed a 5% co-payment only for dentures, and that no co-payment could be made for any other dental services under the program. Further, she admitted that she falsified billings by including services not performed so that Respondent would receive more money under the Medicaid program. The evidence does not establish that she was directed to falsify Medicaid billings by the Respondent or that she informed him of her practices, but it was established that he did not check, or in any way attempt to verify, the billings which she prepared before he signed them.
Recommendation Based upon the foregoing, it is recommended that the Petitioner enter a Final Order suspending Respondent's license for a period of THREE months, and imposing an administrative fine against Respondent in the amount of $6,000.00. DONE AND ENTERED this 24th day of February, 1989 in Tallahassee, Florida. DONALD D. CONN Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 Filed with the Clerk of the Division of Administrative Hearings this 24th day of February, 1989. APPENDIX (DOAH Case No. 88-2961) Rulings on the Petitioner's Proposed Findings of Fact: 1. Adopted in Finding of Fact 1. 2-5. Rejected as unnecessary. 6-8 Adopted in Finding of Fact 2. 9-16. Rejected as unnecessary. Adopted in Findings of Fact 30 and 31. Rejected as unnecessary and as legal argument. 19-25. Adopted in Findings of Fact 30 and 31, but otherwise rejected as simply a summation of testimony. 26. Rejected as unnecessary. 27-30. Adopted in part in Finding of Fact 4. 31-34. Adopted in part in Finding of Fact 5. 35-39. Adopted in part in Finding of Fact 3. 40-42. Adopted in part in Finding of Fact 6. 43-45. Adopted in part in Finding of Fact 7. 46-48. Adopted in part in Finding of Fact 8. 49-51. Adopted in part in Finding of Fact 9. 52-55. Adopted in part in Finding of Fact 10. 56-62. Adopted in part in Finding of Fact 11. 63-65. Adopted in part in Finding of Fact 12. 66-68. Adopted in part in Finding of Fact 13. 69-72. Adopted in part in Finding of Fact 14. 73-76. Adopted in part in Finding of Fact 15. 77-82. Adopted in part in Finding of Fact 16. 83-86. Adopted in part in Finding of Fact 17. 87-90. Adopted in part in Finding of Fact 18. 91-93. Adopted in part in Finding of Fact 19. 94-97. Adopted in part in Finding of Fact 20 98-100. Adopted in part in Finding of Fact 21. 101-103. Adopted in part in Finding of Fact 22. 104-109. Adopted in part in Finding of Fact 23. 110-116. Adopted in part in Finding of Fact 24. 117-119. Adopted in part in Finding of Fact 25. 120-122. Adopted in part in Finding of Fact 26. 123-127. Adopted in part in Finding of Fact 27. 128-130. Adopted in part in Finding of Fact 28. Rejected as unnecessary and duplicative. Adopted in Finding of Fact 29. (Note: In addition to adopting, in part, proposed findings of fact 27-130, as shown above, these proposed findings are otherwise rejected as unnecessary or as not based on competent substantial evidence.) Rulings on the Respondent's Proposed Findings of Fact: Adopted in Finding of Fact 1. Rejected as irrelevant. Adopted in Finding of Fact 2. Rejected as irrelevant. 5-7. Adopted in Finding of Fact 30. 8. Rejected as irrelevant. 9-10. Adopted in Finding of Fact 30. 11-17. Adopted in Findings of Fact 30 and 31. 18-19. Rejected as not based on competent substantial evidence. Adopted in Finding of Fact 31. Rejected as not based on competent substantial evidence and otherwise as irrelevant. 22-23. Adopted in Finding of Fact 31. 24. Rejected as irrelevant. 25-28. Adopted in Finding of Fact 31. 29-30. Adopted in Finding of Fact 30 and 31. 31. Rejected as not based on competent substantial evidence and otherwise as irrelevant. 32-36. Rejected as irrelevant. 37. Adopted in Finding of Fact 29, but otherwise rejected as irrelevant. 38-47. Rejected as irrelevant. 48-49. Adopted in Finding of Fact 4, but otherwise rejected as irrelevant. 50-55. Rejected as irrelevant. 56-60. Adopted and Rejected in Finding of Fact 21, but otherwise rejected as irrelevant. Rejected as argument on the evidence, not a finding of fact. Rejected in Finding of Fact 3. Rejected in Finding of Fact 6. Rejected in Finding of Fact 9. Rejected in Finding of Fact 14. Rejected in Finding of Fact 16. COPIES FURNISHED: Bruce D. Lamb, Esquire 730 South Sterling Street, #313 Tampa, Florida 33609-4582 John A. Powell, Esquire Florida Federal Building One Fourth Street, North Suite 800 St. Petersburg, Florida 33701 William Buckhalt Executive Director Board of Dentistry Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 =================================================================
Findings Of Fact At all times relevant hereto Lorenzo J. Anderson was licensed by the Department of Professional Regulation as a dentist in the State of Florida, having been issued license number DN0008311. On March 12, 1985, Deidre Tomasovic visited the dental office of Respondent for a dental checkup and necessary treatment. Upon arrival at the time scheduled for the appointment Dr. Anderson was not present and the appointment was rescheduled for 11:30 A.M. that same day. At this scheduled appointment Respondent took x-rays of Tomasovic's teeth for which Patricia Krajack (Tomasovic's mother) paid Respondent $65 by check. Respondent also noted work that needed to be done on several of Tomasovic's teeth and scheduled Tomasovic for an appointment to perform this work. No dental work was performed on Tomasovic. Tomasovic arrived for the scheduled appointment but Respondent was not present. Whereupon Ms. Krajack asked for the x-rays to take to another dentist to perform the work indicated on Tomasovic. She then learned that the x-rays had been submitted to Krajack's insurance carrier. Ms. Krajack contacted her insurance carrier to obtain the x-rays and learned that Respondent had submitted a bill for some $875 to the insurance company which included the x-rays for which Krajack had paid as well as work on teeth numbers 10, 11, 15 and 19. (Exhibit attached to Exhibit 3). This dental claim form indicated the dental work was performed on March 12, 25, and April 5, 1985. Subsequent to the discovery of the claim submitted for unperformed dental work and before any other dental work was performed on her, Tomasovic was examined by Dr. William E. Robinson, D.D.S., who was accepted as an expert in general dentistry in these proceedings. On the insurance claim form submitted Respondent showed that on tooth No. 19 he accomplished a post and core restoration, a root canal, and covered the tooth with a gold crown. Dr. Robinson's examination showed only a DOLI amalgam filling was needed for tooth No. 19. On the claim form Respondent showed he performed a composite restoration on tooth No. 10. Dr. Robinson's examination showed only the facial surface of this tooth had decay present. On the claim form Respondent showed that he accomplished a composite restoration of tooth No. 11 (mesial, facial and lingual) when only the mesial and facial required restoration. On the claim form Respondent showed he accomplished a mesial occlusal lingual alloy filling whereas Dr. Robinson found only occlusal decay in this tooth. None of the dental work included on the claim form submitted by Respondent to the insurance company (except the exam and x-rays) was performed on Tomasovic by Respondent. Subsequent to the filing of these charges, Respondent has filed for bankruptcy and indicated he desires to pursue a career other than dentistry (Exhibit 1).
