Elia v. Arizona State Bd. of Dental Examiners
| Decision Date | 04 December 1990 |
| Docket Number | CA-CV,No. 1,1 |
| Citation | 812 P.2d 1039,168 Ariz. 221 |
| Parties | James P. ELIA, D.D.S., Plaintiff-Appellant, v. ARIZONA STATE BOARD OF DENTAL EXAMINERS, Defendant-Appellee. 89-206. |
| Court | Arizona Court of Appeals |
This appeal challenges a decision of the Superior Court affirming disciplinary sanctions imposed against James P. Elia, D.D.S. (appellant) by the Arizona State Board of Dental Examiners (the "Board").
Timothy Hoffman consulted with Dr. Elia for treatment of severely eroded teeth. Elia discussed restorative options with Hoffman and suggested a procedure involving root canals, posts and crowns, the best treatment available. Hoffman could not afford this procedure. Elia then offered to fabricate an appliance ("splint") for the affected teeth.
Elia cemented the splint into place and suggested it be worn on a temporary basis. Hoffman told Elia he did not want to experience the painful seating process again and began to wear the splint permanently. Elia provided Hoffman with instructions for care of the splint and proper oral hygiene. Hoffman followed these directions but was unable to use a floss threader to clean between the units of the splint as he had been instructed.
Hoffman returned twice to Elia's office to have his teeth cleaned. Elia reiterated the importance of following the recommended oral hygiene. Hoffman continued to suffer from gingivitis, bleeding, and began to feel that food was trapped under the splint. Hoffman did not return again to Elia's office for treatment.
Over the course of his treatment by Elia, Hoffman became acquainted with Ms. Roxanne Watson, a dental assistant employed by Elia. Hoffman and Watson subsequently married.
Hoffman consulted another dentist, William Daine, D.D.S., eight months after the splint was inserted. Dr. Daine referred Hoffman to a periodontist, Dr. Louis Robertson. Robertson examined Hoffman and concluded that periodontal treatment was necessary and that restoration should involve single-unit crowns throughout the affected area. In Robertson's opinion, the splint was seated too far below the gumline, and had resulted in "inflammation, fibrosis, and symptomatic discomfort."
Hoffman filed a complaint with the Board. The Board referred the matter to an investigative committee pursuant to A.R.S. § 32-1263.02(C). The investigative committee, consisting of two dentists, performed an assessment of Elia's work, including an examination of Hoffman's mouth and the splint. Dr. Gary Gilliam, a member of the evaluation team, concluded that the splint was an ongoing hazard to Hoffman's dental health because it was loose, had inadequate embrasure spaces, was difficult to clean and caused marked gingivitis around the splint area.
The investigative committee informed Elia that it intended to deliberate regarding the findings of the clinical evaluation committee. The notice stated that the basic allegation in the complaint against him was "inadequate crown and bridge causing perio problems due to inability of patient to maintain tissue health." The notice further stated that proof of this allegation would constitute a violation of A.R.S. § 32-1201(16). That provision defines "unprofessional conduct" as "any conduct or practice which does or would constitute a danger to the health, welfare or safety of the patient or the public." A.R.S. § 32-1201(16)(n).
In response to the Board's notice of intent to conduct a deliberation meeting, counsel for Elia demanded to conduct discovery and cross-examine members of the investigative committee. The Board cancelled the deliberation meeting and the matter was scheduled for an informal interview pursuant to A.R.S. § 32-1263.02(C)(1). Elia refused to cooperate during the informal interview. The Board scheduled the matter for a formal hearing pursuant to A.R.S. § 32-1263.02(C).
The Board's investigation revealed that Watson asked Elia, her employer, to prescribe the antibiotic tetracycline for Hoffman, her husband. Watson told Elia she was suffering from a highly contagious vaginal infection and needed the prescription for her husband to prevent him from sexually contracting the infection and then reinfecting her. Elia prescribed the tetracycline. Elia did not examine or speak with Hoffman before or after he prescribed the antibiotic for him.
Watson photocopied Elia's office records regarding her husband's treatment without Elia's knowledge. Those photocopies were attached to Hoffman's complaint filed with the Board. A comparison of Elia's original records with the photocopied records revealed that Elia had made additional entries in Hoffman's chart after Watson had copied the records. Elia supplemented the records with information regarding the treatment plan, his clinical evaluations and the prescription for tetracycline.
The Board issued a complaint and notice of formal hearing with six allegations of "unprofessional conduct" pursuant to A.R.S. § 32-1201(16): (1) the treatment plan was inadequate because the splint was inappropriate for Hoffman; (2) the splint lacked adequate embrasure spaces which prevented proper oral hygiene; (3) Hoffman's teeth had been overtapered, which contributed to a gingival response; (4) the overtapering resulted in the loss of a
tooth; (5) Elia's supplementation of
Hoffman's records constituted false and
misleading statements pursuant to
A.R.S. § 32-1201(16)(l ); and (6) Elia had prescribed tetracycline to Hoffman for other than an accepted therapeutic dental purpose.
At the formal hearing, the hearing officer prepared findings of fact and conclusions of law as follows: (1) the embrasure spaces in the splint were inadequate and the subgingival seating of the splint was improper, constituting unprofessional conduct pursuant to A.R.S. § 32-1201(16) and A.A.C. R4-11-1101; (2) the tetracycline had been prescribed for Hoffman for other than "therapeutic purposes" and thus constituted unprofessional conduct pursuant to A.R.S. § 32-1201(16)(c); and (3) the supplementations of Hoffman's dental records were meant to appear contemporaneous with the original entries, and thus were false and fraudulent, constituting unprofessional conduct pursuant to A.R.S. § 32-1201(16)(l ).
The Board issued findings of fact and conclusions of law virtually identical to those prepared by the hearing officer. The Board censured Elia for prescribing the tetracycline, for supplementing Hoffman's treatment records, for fabricating the splint with the inadequate embrasure spaces and for the subgingival seating of the splint. The Board ordered Elia to pay restitution to Hoffman for the cost of the splint, an administrative penalty of $4,000.00 and to serve twelve months probation.
Elia petitioned the Board for a rehearing. The Board denied Elia's petition and affirmed the sanctions. The trial court affirmed the Board's order and dismissed Elia's action. In this appeal, Elia alleges that the allegations of unprofessional conduct were not supported by the evidence and that he was denied due process of law in the proceedings before the Board.
The trial court's review of an administrative agency decision is limited to whether the agency's action was illegal, arbitrary, capricious or involved an abuse of discretion. Schmitz v. Ariz. State Bd. of Dental Exam., 141 Ariz. 37, 684 P.2d 918 (App.1984). The trial court may not substitute its own judgment for that of the agency where factual questions and agency expertise are involved. De Groot v. Arizona Racing Commission, 141 Ariz. 331, 686 P.2d 1301 (App.1984). Nor may we do so. To resolve factual issues on appeal, such as those raised by Elia, this court must review the record to determine whether it contains evidence supporting the Board's decision. Webster v. State Board of Regents, 123 Ariz. 363, 599 P.2d 816 (App.1979). Where the facts are in conflict, we must affirm a board decision which is supported by substantial evidence. Zavala v. Arizona State Personnel Bd., 159 Ariz. 256, 766 P.2d 608 (App.1988).
The Board found that two facets of Elia's treatment of Hoffman constituted a danger to his health and were "unprofessional" pursuant to A.R.S. § 32-1201(16)(n). Elia alleges that these findings were without substantial evidence. We disagree.
The Board concluded the splint's embrasure spaces were too small, which prevented Hoffman from maintaining proper oral hygiene, resulting in gingivitis and bleeding as well as a feeling that food was trapped under the splint. Hoffman's failure to follow Elia's instructions for proper oral hygiene does not defeat the claim of improper treatment. The Board found the construction of small embrasure spaces violated the guidelines for assessment of clinical quality and professional performance in A.A.C. R4-11-1101. The rule states in pertinent part, "[r]estorations should exhibit contours that are in functional harmony with adjacent teeth and soft tissues, exhibiting good individual and anatomic form; no food traps or soft tissue irritation are present and design should facilitate good oral hygiene." A.A.C. R4-11-1101.
The Board based its finding upon the testimony of Dr. Gilliam, who, as part of the investigative committee of the Board, examined Hoffman and the splint. Gilliam testified that the embrasure spaces were too small for good oral hygiene. Conversely, Elia's witness, Dr. Michael D'Mura, who never examined Hoffman or the splint, testified that the embrasure spaces were adequate given the poor condition of Hoffman's teeth.
Elia alleges that this apparent conflict in expert testimony means that there was insufficient evidence to conclude that the embrasure spaces...
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