13-003286PL Department Of Health, Board Of Dentistry vs. Pasquale Almerico, Jr., D.D.S. Status: Closed Recommended Order on Wednesday, July 9, 2014.

Summary: Evidence failed to demonstrate clearly and convincingly that Respondent's treatment fell below the minimum standard of care. Recommend dismissal of Amended Administrative Complaint.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF HEALTH, BOARD OF

DENTISTRY ,

Petitioner,

vs. Case No. 13 - 3286PL

PASQUALE ALMERICO, JR., D.D.S. ,

Respondent.

________________________________ /

R ECOMMENDED ORDER

Administrative Law Judge Edward T. Bauer held a final

hearing in this case by video teleconference between sites in

Miami and Tallahassee, Florida, on November 8, 2013, and in

Tallahassee, Florida, on April 9, 2014.

APPEARANCES

For Pet i tioner: Gail Scott Hill, Esquire

Department of Health

4052 Bald Cypress Way, Bin C - 65

Tallahassee, Florida 32399

For Respondent: Max R. Price , Esquire

Law Offices of Max R. Price , P.A.

6701 Sunset Drive, Suite 104

Miami, Florida 33143

STATEMENT OF THE ISSUE S

The issues in this case are whether Respondent committ ed

the allegations contained in the Amended Administrative

Complaint and , if so, the penalty that should be imposed.

PRELIMINARY STATEMENT

On May 28, 2013 , Petitioner, Departm ent of Hea lth, Board of

Dentistry, filed an Amended Administrative Complaint ( Ð Amended

Complaint Ñ ) agai nst Respondent, Dr. Pasquale Al m erico . The

Amended Complaint , which comprises one count, alleges that

Respondent violated section 466.028(1)(x), Florida Statutes

(2009) , in that his treatment of patient P.D. fell below the

appropriate standard of care in one or both of th e following

ways: by failing to remove existing carries (i.e., decay) on

tooth number 20 before seating a bridge at teeth numbers 19, 2 0,

and 21 ; and/or by failing, subsequent to the seating of the

bridge, to take x - rays or otherwise rule out endodontic

involvement in response to repeated compl aints of dental pain.

Respondent timely requested a formal hear ing to contest the

allegations a n d, on August 29 , 201 3 , the matter was referred to

the Division of A dministrative Hearings ( Ð DOAH Ñ ) and assigned to

Administrative Law Judge John G . Van Laningham. On November 7,

2013, Judge Van Lani ngham transferred this cause to the

undersigned for furth er proceedings.

As noted above, the final hearing in t his matter was held

on November 8, 2013, and April 9, 2014, during which Petitioner

presented the testimony of Dr. Solomon Brotman and introduced

eight exhibits, numbered 1 through 8 . 1 / Respondent tes tified on

his own behalf, presente d the testimony of Dr. Robert Fish , and

introduced ten exhibits, numbered 3 through 5, and 7 through 13.

The final hearing Transcript of the April 9, 2014,

proceedings was f iled with DOAH on April 30, 2014 . (The

Tran script of the first day of final hearing was filed on

November 27, 2013.) Thereafter, at Respondent's request, the

undersigned extended the deadline for the submission of proposed

recom mended orders to June 2, 2014. Both parties submitted

proposed recomm ended orders, which the undersigned has

considered in the preparation of this Recommended Order.

FINDINGS OF FACT

A. The Parties

1 . Petitioner Department of Health has regulatory

jurisdiction over licen sed dentists such as Respondent . In

particula r, Petitioner is authorized to file and prosecute an

administrative complaint, as it has done in this instance, when

a panel of the Board of Dentistry has found probable cause

exis ts to suspect that the licensee has committed one or more

disciplinable offe nses.

2. Respondent Pasquale Almerico, Jr., a graduate of the

University of Pennsylvania Schoo l of Dental Medicine, has been

licensed to practice dentistry in the State of Florida since

1984. Respondent's address of record is 704 North Alexander

St r eet, Plant City, Florida.

B. The Events

3 . On February 16, 2010, patient P.D., a 60 - year - old

female, presented to Res pondent's dental office to discuss the

replacement of a partial, removable denture t hat was causing

discomfort. The partial denture, which another dentist

installed some 15 years earlier to fill the gaps created by lost

teeth in the lower - left portion of P.D.'s mouth ÏÏ specif ically,

teeth numbers 18 and 19 ÏÏ was secured by a metal Ð C - clasp Ñ

attached to tooth number 20.

4. Noticing imm ediately that the partial denture was ill

fitting, Respondent recommended its replacement with a three -

unit cantilever bridge at teeth numbers 19, 20, and 21. As

explained during the final hearing, a cantilever is a type of

fixed bridge that attaches to a djacent teeth on one end only.

Thus, in this instance, abutment crowns on teeth numbers 20 and

21 would connect to a pontic (an artificial tooth) extending

into the gap formerly occupied by tooth number 19.

5. P.D. consented to the suggested treatment d uring the

February 16 office visit, at which point Respondent removed the

existing crown on tooth number 20, took a radiograph of the

relevant area, and performed a thorough clinical examination of

teeth numbers 20 and 21 . Although Respond ent observed som e

abrasion 2 / on the distal surface of tooth number 20 where the C -

clasp of the partial denture had been attached , the teeth

otherwise appeared healthy ÏÏ i.e., neither Respondent's d irect

visualization of the teeth nor his review of the radiograph

suggested the pr esence of decay .

6. At the conclusion of the February 16 visit , Respondent

prepared teeth numbers 20 and 21 (a process that involves the

use of a drill to remove enough enamel from the teeth so that

the bridge will fit properly), took a final imp ression, and

provid ed P.D. with a temporary bridge.

7. P.D. returned to Respondent's office on March 3, 2010,

at which time Respondent remove d the temporary bridge and

performed a Ð tr y - in Ñ with the metal framework of the new bridge .

During this proc ess, Respondent directly visualized tooth

number 20 and , as was the case during the previous visits ,

observed no signs of d ecay. 3 / However, Respondent noticed that

the metal framework would not seat correctly, which prompted him

to take a new impression.

8. Thereafter, on March 10, 2010, Respondent removed

P.D.'s temporar y bridge and conducted a try - in with the new

metal framework ÏÏ affording him a third opportunity to visualize

tooth number 20. Once again, Respondent observed no indications

of dec ay or any other issues. Of the opinion that th e second

impression had yielded a satisfactory framework , Respondent

scheduled P.D. to return at a later date for the seating of her

new bridge.

9. Upon P.D. 's return on March 24, 2 010, Respondent

removed the temporary bridge and directly visualized tooth

number 20 for a fourth time; no decay was observed. Respondent

then proceeded to seat the cantilever bridge, which fit well and

caused the patient no discomfort. At that point, it was

anticipated that P. D. would follow up with Respondent in six

months for routine cleaning and maintenance.

10. As it happens, though, P.D. retu rned to Respondent's

office a mere five d ays later , on March 29, 2010. During the

visit, P.D. reported that her new bridge was Ð hu rting Ñ and that

s he was feeling Ð pressure constantly. Ñ Notably, however, P.D.

denied that the pain was of such intensity that i t kept her

awake at nighttime, which militated against a conclusion tha t

the patient was suffering from an abscess . 4 /

11. In response to P.D.'s complaints , Respondent adjusted

and flossed the bridge. T hat an adjustment was made so soon

after the bridge's seating , although less than optimal , was by

no means unusual ; indeed, Peti tioner's expert witness concedes

that neither the timing of the March 29 visit nor P.D.'s report

of pressure necessitated a clinical examin ation or the taking of

an x - ray on that date. 5 /

12. Nine days later, on April 7 , 2014, P.D. appeared at

Respondent's office on c e again, this time with the complaint

that she was biting her cheek. During the clinical examination

that ensued, Respondent surmised that the cheek bit ing, if any,

had been caused by a different , aging bridge located in the

upper left of P.D.'s mouth (at teeth numbers 11 through 14) . 6 /

Res pondent did, however, notice that the new bridge was hitting

high, which promp ted him to make a minimal adjustment using a

rubber wheel.

13. Although Petitioner contends that Respondent should

have taken an x - ray during the April 7 visit t o rule out an

abscess , the evidence demonstrates that P.D. exhibited no n e of

the clinical symptoms sometimes attendant to such a condition.

Save for her report of Ð cheek biting , Ñ P.D. presented with no

complaint of severe ÏÏ or, for that matter, any ÏÏ pain, 7 / nor did

she exhibit any discomfort during the adjustment. Moreover ,

P.D. did not react adversely when Respondent used the end of his

examination mirror to perform percussion on the bridge.

Finally, Respondent detected no inflammation below the gum line.

14. Sub sequently, on April 13, 2010, P.D. returned to

Respondent's office and reported that the new bridge was

Ð catching her lip. Ñ P.D. complained of no other pain relating

to the new bridge , and Respondent's clinical examination yielded

no indications (e.g., th ermal sensitivity or sensitivity to

percussion) that the patient was suffering from an abscess. 8 /

Owing to the dearth of symptoms suggestive of endodontic

involvement , Respondent determined that an x - ray was

unnecessary. However, Respondent made a minim a l adjustment to

the new bridge and sent P.D. on her way, with the expectation

that the patient would return in six months for a follow - up

visit.

15. Although P.D. would return a mere six days later, on

Apri l 19, 2010, her complaints at that time related only to the

aging bridgework at teeth numbers 11 through 14 (seated years

earlier by another dentist), which Respondent discovered was

Ð hitting hard. Ñ Significantly, P.D. raised no issues concerning

her new bridge at teeth numbers 1 9 through 21 , and Respo ndent's

examination revealed, yet again, no signs of endodontic

involvement. 9 / As such, Respondent did nothing more than make a

slight adjustment to the bridge at teeth numbers 11 through

14. 10 /

16. Soon thereafter, P.D. scheduled another appointment

and returned to Respondent's office on April 27. On this

occasion, as with the previous visit , P.D. voiced no complaints

concerning her new bridge, and Respondent observed no signs of

inflammation, cheek biting, or any problems. This time,

however, P.D. acc used Respondent of Ð breaking Ñ the bridgework at

teeth numbers 11 through 14 and suggested that he provide a

replacement free of charge.

17. Respondent was understandably dismayed by P.D.'s

demand , for he had never caused any damage to the 11 through 14

b ridge ; moreover, the bridge in question, al though in poor

condition , was by no means Ð broken. Ñ At t hat point, Respondent

terminated his relationship with P.D.

C. Expert Testimony

18. As noted previo usly, Petitioner advances two unrelated

theories i n support of its charge that Respondent violated the

minimum standard of care. First, Petitioner contends that,

prior to the seating of the new bridge on March 24, 2010,

Respondent failed to treat decay supposedly present on the

distal surface (i.e., the part of the tooth that faces the back

of the mouth) of tooth number 20. In light of Respondent's

concession that the standard of care require s the removal of

existing decay prior to the seating of a bridge, Petitioner's

first theory boils down to a factua l dispute over whether decay

was present on to oth number 20 on March 24, 2010.

19. In an attempt to establish the presence of decay,

Petitioner adduced testimony from Dr. Solomon Brotman, an

eminently qualified dentist with more than 30 years of pr actical

experience. Although Dr. Brotman concedes that he never

clinically examined P.D., he nevertheless maintains that the

presence of Ð substantial Ñ decay on tooth number 20 is

demonstrated by x - rays in Respondent's possession when the

bridge was seated . 11 / Dr. Brotman further opines that the x - rays

of tooth number 20 are not reasonably susceptible to any other

interpretation (e.g., abrasion or erosion ), an d that Respondent

may have missed the decay because it is Ð sometimes Ñ tooth

colored. Finally, Dr. Brotman asseverates that, in cases

involving interproximal decay, it is appropriate to make a

diagnosis based solely on an x - ray.

20. Respondent counters with testimony from Dr. Robert

Fish, an expert with an equally impressive background , who

credibly asserts that the x - rays in question are not suggestive

of decay but, rather, abrasion 12 / that likely resulted from the

ill - fitting Ð C - clasp Ñ of the removable partial denture ÏÏ an

opinion that jibes with Respondent's persuasive testimony that

he observed abra sion on the distal surface of tooth number 20.

Dr. Fish further contends that, had decay been present, it is

highly unlikely that Respondent would have missed it given the

number of times he directly visualized tooth number 20 prior to

the seating. 13 /

21. The short of it is that decay quite possibly existed

on the distal surface of tooth number 20 at the time Respondent

seated the bridge. However, Respondent's persuasive account of

his clinical observations of the tooth, buttressed by the

credible te stimony of Dr. Fish, leaves the unde rsigned with

substantial doubt on this point . As such, Petitioner has failed

to sustain its burden of proof.

22. The undersigned now turns to Petitioner's alternative

theory, namely, that Ð continuing, localized dent al p ain Ñ

required Respondent to rule out the possibility of an abscess at

the root of tooth number 20. In relevan t part, the Amended

Complaint alleges:

23. Continuing, localized dental pain is a

symptom of endodontic involvement.

24. Minimum standards of diagnosis and

treatment in the practice of dentistry

require that when a patient complains of

continued dental pain , a dentist take

radiographic images of the symptomatic area

to determine whether there is endodontic

involvement. . . .

26. Patient ap pointed with Respondent for

relief of pain five times [after the bridge

was seated] . . . .

27. Respondent Dr. Almerico did not take

radiographs of that area or otherwise rule

out endodontic involvement during those

visits.

28. By failing to take radi ographic images

to determine possible endodontic involvement

at bridge #19 - 21 , Respondent failed to meet

minimum standards of dental diagnosis and

treatment when measured against generally

prevailing peer performance.

(emphasis added).

23. Fairly read , the Amended Complaint alleges the

standard of care as follows: when a patient reports continuing,

localized dental pain , a practitioner must take an x - ray of the

symptomatic area or otherwise rule out endodontic involvement .

24. As Respondent correc tly argues, however, t he testimony

of Petitioner's expert departs substantially from the the ory

pleaded in the charging document . First, contrary to paragraph

27 of the Amended Complaint, which alleges a failure to take x -

rays Ð or otherwise rule out Ñ an a bscess, Dr. Brotman's

formulation of the standard of care absolutely requires the

taking of an x - ray to eliminate the possibility of endodontic

involvement. To muddy the waters further, Dr. Brotman's

articulation of the prevailing standard at times focuse d not on

P.D.'s supposed reports of continued pain but, rather, the fact

that Respondent made more than one adjustment to the new b ridge

subsequent to its seating :

A Sure. I think we fell below the minimum

standards on 4/7, 4/13 and 4/19 of 2010,

bec ause each of those visits, because the

patient came back with the bite having

shifted, which for that reason Dr. Almerico

continued to adjust the bite on each visit .

* * *

BY MR. PRICE:

Q Doctor, you just gave an opinion that is

the standard of care th at a patient with

more than one adjustment , they automatically

get an X - ray. You just gave that as a

standard - of - care opinion, didn't you?

A Yes, sir.

(emphasis added). 14 /

2 5 . In light of the significant degree to which Dr.

Brotman's testimony dev iates from the theory charged in the

Amended Complaint , it is concluded that Petitioner has failed to

convincingly articulate the minimum standard of performance

against which the undersigned, as fact - finder, can independently

evaluate Respondent's conduct .

26 . Even assumin g that Petitioner had established the

standard of care (as pleaded) , the re is a dearth of credible

evidence that P.D. presented with continuing , localized pain

relating to the new bridge. As detai led previously, P.D.'s

report on Apr il 7 that she was Ð biting her cheek Ñ involved the

older bridge at teeth numbers 11 through 14; on her next visit,

she complained only that her new bridge was Ð catching her lip Ñ ;

on April 19, P.D. merely informed Respondent that the older

bridge was Ð hittin g hard Ñ ; and, on her final visit, P.D.

complained of nothing at all (save for her dubious request for a

free replacement of the older bridge). 15 / Such hardly

con stitutes a pattern of ongoing , localized pain.

27 . I n any event, the persuasive evidence de monstrates

that Respondent Ð otherwise ruled out Ñ endodontic involvement

through his clinical observations. Indeed, as Dr. Fish

persuasively explained during his testimony , P.D. presented with

none of the symptoms 16 / sometimes associated with the presence o f

an abscess ÏÏ e.g., sensitivity to temperature, exquisite pain,

sensitivity to percussion, a fistula, or inflammation ÏÏ during

the office visits of April 7, 13, 19, and 27, 2010, thereby

obviating the need for an x - ray.

D. Ultimate Factual Determinations

28 . It is determined, as a matter of ultimate fact, that

Respondent is not guilty of violating section 466.028(1)(x).

CONCLUSIONS OF LAW

A. Jurisdiction

29 . DOAH has jurisdiction over the parties and subject

matter of this cause, pursuant to se ction 120.57(1), Florida

Statutes (2013) .

B. The Burden and Standard of Proof

3 0 . This is a disciplinary proceeding in which Petitioner

seeks to discipline Respondent ' s licen se to practice dentistry .

Accordingly, Petitioner m ust prove the allegations contained in

the Amended Administrative Complaint by clear and convincing

evidence. Dep ' t of Banking & Fin., Div. of Secs. & Investor

Prot. v. Osborne Sterne, Inc. , 670 So. 2d 932, 935 (Fla. 1996);

Ferris v. Turlington , 510 So. 2d 292 , 294 (Fla. 1987).

3 1 . Clear and convincing evidence:

[R]e quires that the evidence must be found

to be credible; the facts to which the

witnesses testify must be distinctly

remembered; the testimony must be precise

and lacking in confusion as to the facts in

issue. The evi dence must be of such a

weight that it produces in the mind of the

trier of fact a firm belief or conviction,

without hesitancy, as to the truth of the

allegations sought to be established.

Slomowitz v. Walker , 429 So. 2d 797, 800 (Fla. 4th DCA 1983) .

C . Statutory Construction/Notice

32. Disciplinary statutes and rules Ð must be construed

strictly, in favor of the one against whom the penalty would be

imposed. Ñ Munch v. Dep't of Prof'l Reg., Div. of Real Estate ,

592 So. 2d 1136, 1143 (Fla. 1st DCA 199 2); McClung v. Crim.

Just. Stds. & Training Comm'n , 458 So. 2d 887, 888 (Fla. 5th DCA

1984)( Ð [W]here a statute provides for revocation of a license

the grounds must be strictly construed because the statute is

penal in nature. No conduct is to be regarded as included

within a penal statute that is not reasonably proscribed by it;

if there are any ambiguities included, they must be construed in

favor of the licensee. Ñ ).

33 . Due process prohibits an agency from taking

disciplinary action against a licensee based on matters not

specifically alleged in the charging instrument. § 120.60(5),

Fla. Stat. ( Ð No revocation, suspension, annulment, or withdrawal

of any license is lawful unless, prior to the entry of a final

order, the agency has served, by personal se rvice or certified

mail, an administrative complaint which affords reasonable

notice to the licensee of facts or conduct which warrant the

intended action . . . . Ñ ) ; Trevisani v. Dep't of Health , 908

So. 2d 1108, 1109 (Fla. 1st DCA 2005)( Ð A physician may n ot be

disciplined for an offense not charged in the complaint Ñ ); Delk

v. Dep't of Prof'l Reg. , 595 So. 2d 966, 967 (Fla. 5th DCA

1992)( Ð [T]he conduct proved must legally fall within the statute

or rule claimed [in the administrative complaint] to have been

violated Ñ ) ; Dep't of Fin. Servs. v. Calvo , Case No. 07 - 5648PL,

2008 Fla. Div. Adm. Hear. LEXIS 820, *24 (Fla. DOAH July 24,

2008)( Ð Such a theory, however, cannot support a finding of guilt

in the instant case inasmuch as it was not advanced in the

Adminis trative Complaint Ñ ); Dep't of Ins. & Tr easurer v.

Gottlieb , Case No. 92 - 1902, 1993 Fla. Div. Adm. Hear. LEXIS

5893, *6 (Fla. DOAH July 26, 1993)( Ð Agencies cannot take

disciplinary action against a licensee on the basis of . . .

legal theories not asserted in the Administrative Complaint. Ñ ).

D . The Charge Against Respondent

34 . With the foregoing principles in mind, the undersigned

turns to Count I of the Amended Complaint, which charges

Respondent with violating section 466.028(1)(x), a provision

that s ubjects a licensee to discipline for :

B eing guilty of incompetence or negligence

by failing to meet the minimum standards of

performance in diagnosis and treatment when

measured against generally prevailing peer

performance, including . . . dental

malpract ice.

35. As discu ssed earlier , Petitioner advances two

unrelated theories in support of the charge: that Respondent

failed to remove decay from tooth number 20 prior to seating the

new bridge at teeth 19 through 21; and/or that Respondent

neglected to take an x - ray or otherwise rule out endodontic

involvement in response to an alleged pattern of localized

dental pain .

36. Fo r the reasons elucidated previously , Petitioner's

first theor y fails as a matter of fact, as there is an absence

of clear and convincing evidence that decay existed on tooth

number 20 at the time the bridge was seated.

37. Petitioner's second theory fares no better, for, as

explained above, the testimony of its expert concerning the

minimum standard of care departed significa ntly from the theory

advanced in the Amended Complaint. Further, e ven if the

standard articulated in the charg ing document had been proven

clearly and convincingly , the credible evidence establishes

that, notwithstanding the lack of an x - ray, the possibil ity of

endodontic involvement was Ð otherwise Ñ ruled out by virtue of

Respondent's clinical observations.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law, it is RECOMMENDED that a final order be entered by th e

Board of Dentis try dismissing Count I of the Amended

Administrative Complaint.

DONE AND ENTERED this 9 th day of July, 2014 , in

Tallahassee, Leon County, Florida.

S

___________________________________

EDWARD T. BAUER

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallaha ssee, Florida 32399 - 3060

(850) 488 - 9675

Fax Filing (850) 921 - 6847

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 9 th day of July, 2014 .

ENDNOTES

1 / The depositi on transcript of Patient P.D. (identified as

Petitioner 's Exhibit 7 ) has been received in lieu of t he

witness' live testimony.

2 / Nov. 8, 2013, Hr'g Tr. 131:12 - 133:3.

3 / Nov. 8, 2013, Hr'g Tr. 142:24 - 143:12.

4 / Nov. 8, 2013, Hr'g Tr. 149:7 - 13; Apr. 9, 2014, Hr'g Tr.

51:14 - 52:3. P.D.'s testimony to the contrary is rejected in

favor of Respondent's account.

5 / Nov. 8, 2013, Hr'g Tr. 43:24 - 25.

6 / Nov. 8, 2013, Hr'g Tr. 152:12 - 153:8.

7 / Nov. 8, 2013, Hr'g Tr. 153:9 - 12.

8 / Nov. 8, 2013, Hr'g Tr. 166:20 - 167 - 5.

9 / Nov. 8, 2013, Hr'g Tr. 168:8 - 14; 169:15 - 170:3.

10 / Within hours of her April 19 office visit, P.D. telephoned

Respondent and advised that she was "biting the inside of her

cheek" ÏÏ a complaint she never m entioned during the appointment.

To alleviate any discomfort to P.D.'s cheek, Respondent

recommend ed Ibuprofen and salt water rinses.

11 / To a lesser extent, Dr. Brotman's opinion is also based on

notations of decay found in the records of three other dentists:

Dr. Digamon, whose treatment of P.D. predated that of

Respondent ; and Drs. Crim and Kantwill, who saw P.D. (with the

new bridge still cemented in place) more than four months after

Respondent terminated his relationship with the patient.

Notably , however, Dr. Brotman admits that he is without

knowledge as to whether these practitioners c linically confirmed

the existence of decay. Nov. 8, 2013 , Hr'g Tr. 62:3 - 25; 95:2 - 4;

97:24 - 98:6. Thus, on this record, there is no evid ence that

anyone other than Respondent ÏÏ a dentist with more than 25 years

of practical experience ÏÏ had occasion to direc tly visualize the

distal surface of tooth number 20.

12 / Apr. 9, 2014, Hr'g Tr. 19:14 - 17; 24:24 - 25:6.

13 / Apr. 9, 2014, Hr'g Tr. 39:22 - 40:3.

14 / Nov. 8, 2013, Hr'g Tr. 45:24 - 46:3; Apr. 9, 2014, Hr'g Tr.

191:11 - 16.

15 / P.D.'s testimony that s he repeatedly complained of extreme

pain is rejected in favor of Respondent's recounting of the

events, which the undersigned credits in its entirety.

16 / Apr. 9, 2014, Hr'g Tr. 50:18 - 51:7; 52: 19 - 25; 53:4 - 8.

COPIES FURNISHED:

Susan Foster, Execut ive Director

Board of Dentistry

Department of Health

4052 Bald Cypress Way, Bin C - 08

Tallahassee, Florida 32399

Jennifer A. Tschetter, General Counsel

Department of Health

4052 Bald Cypress Way, Bin A - 02

Tallahassee, Florida 32399

Gail Scott Hill, E squire

Department of Health

4052 Bald Cypress Way, Bin C - 65

Tallahassee, Florida 32399

Max R. Price , Esquire

Law Offices of Max R. Price , P.A.

6701 Sunset Drive, Suite 104

Miami, Florida 33143

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days from the date of this Recommended Order. Any exceptions

to this Recommended Order should be filed with the agency that

will issue the Final Order in this case.