Appeal by respondent from order dated 5 April 2002 by Judge
David Q. LaBarre in Wake County Superior Court. Heard in the Court
of Appeals 18 February 2003.
Rush-Lane & Lane, P.L.L.C., by Freddie Lane, Jr., for
petitioner appellee.
Bailey & Dixon, L.L.P., by M. Denise Stanford, for respondent
appellant.
BRYANT, Judge.
The North Carolina State Board of Dental Examiners (the Board)
appeals a superior court order dated 5 April 2002 reversing the
Board's final agency decision to suspend the dental license of
orthodontist Paul E. Watkins, D.D.S. (Dr. Watkins).
Based on the formal complaints of three of Dr. Watkins'
patients, the Board held an administrative hearing to determine
whether Dr. Watkins had violated N.C. Gen. Stat. §§ 90-41(a)(6),
(12), and (13). The record and evidence presented at this hearing
revealed the following as to the individual patients:
Sabrina A. Wolfe
In her complaint dated 31 March 1999, Sabrina A. Wolfe (Wolfe)
stated that she started seeing Dr. Watkins at his Greensboropractice in January 1997. Dr. Watkins placed braces on Wolfe's
teeth, and according to Wolfe, she received fair treatment from
his practice. [A]round August or September of 1997, Wolfe
contacted the office . . . to tell [Dr. Watkins she] did not want
to see [him] anymore because of financial reasons [and because she]
wanted an office in High Point where [she] live[s]. At this time,
Wolfe was told she still owed Dr. Watkins for his past services.
In spite of her termination notice, Dr. Watkins' treatment record
indicates that Wolfe came to the practice again on 8 October 1997
but was rescheduled due to non-payment. On 26 November 1997,
Wolfe presented herself to Dr. Watkins once more and was again not
seen due to non-payment.
Dr. N. Watt Cobb, Jr., the Board's expert witness on the Wolfe
allegations, testified it was a breach of the standard of care for
dentists, including orthodontists, to deny treatment to a patient
of record who was delinquent in her payments without first giving
that patient time to find another orthodontist. Based on this
testimony, the Board found:
7. The standard of care for dentists
licensed to practice dentistry in North
Carolina at the time [Dr. Watkins] treated
. . . Wolfe required that once orthodontic
treatment is initiated, the dentist must
continue to treat a patient with an
outstanding balance until that patient has
been formally dismissed by the practice and
given a period of time to find another dentist
to continue treatment.
8. [Dr. Watkins] violated the standard of
care for dentists licensed to practice
dentistry in North Carolina by failing to
treat . . . Wolfe because she had anoutstanding balance on her account.
Based on these findings, the Board concluded that Dr. Watkins'
failure to comply with the applicable standard of care in his
treatment of . . . Wolfe as set forth in Finding of Fact No. 8 was
a dereliction from professional duty constituting negligence in the
practice of dentistry within the meaning of G.S. § 90-41(a)(12).
John Matt Casto
On 22 April 1996, John Matt Casto (Casto), a minor, presented
himself to Dr. Watkins for an orthodontic consultation. Dr.
Watkins diagnosed Casto as having a Class I malocclusion with
severely crowded locked-out maxillary bicuspids and severely
crowded mandibular anterior incisors. Dr. Watkins considered
extracting two of Casto's adult teeth but, in the end, decided to
pursue a conservative approach using orthodontic appliances and
avoiding extraction until absolutely necessary. On 22 October
1997, Dr. Watkins finally recommended extraction, which was
subsequently performed by another dentist. During the course of
his treatment, Casto experienced excessive appliance breakage
leading to a delay in his progress. Dissatisfied with the lack of
progress, Casto's mother sought the services of another
orthodontist in the fall of 1998.
Dr. Christopher John Trentini, an orthodontist, testified as
the Board's expert witness with regard to Casto. While Dr.
Trentini disagreed with Dr. Watkins' choice of treatment plan and
testified that Dr. Watkins' treatment of Casto was behind schedule,
Dr. Trentini did not state how far behind Casto's treatment was orthat the delay violated the standard of care for orthodontists.
Dr. Trentini also did not testify that Dr. Watkins' treatment of
Casto was in violation of the standard of care. During cross-
examination, Dr. Trentini conceded that excessive appliance
breakage would extend a patient's treatment time.
The Board found in pertinent part that:
12. [Dr. Watkins'] orthodontic treatment
of . . . Casto was inappropriate in that the
treatment plan and subsequent treatments
rendered failed to address the orthodontic
needs of the patient in a timely manner.
13. The standard of care for dentists
licensed to practice dentistry in North
Carolina at the time [Dr. Watkins] treated
. . . Casto required an orthodontist to
establish and follow a treatment plan which
would address the patient's orthodontic needs
in a timely manner.
14. [Dr. Watkins] violated the standard
of care for dentists licensed to practice
dentistry in North Carolina by failing to
establish and follow a treatment plan that
would address the patient's orthodontic needs
in a timely manner.
Accordingly, the Board concluded Dr. Watkins' failure to comply
with the applicable standard of care in his treatment of . . .
Casto . . . was a dereliction from professional duty constituting
negligence in the practice of dentistry within the meaning of G.S.
§ 90-41(a)(12).
Harry Conrad Naico
Harry Conrad Naico (Naico) sought orthodontic treatment from
Dr. Watkins in December 1996 when Naico was twelve years old. Dr.
Watkins diagnosed Naico as having a Class II malocclusion, a onehundred percent overbite, and a four to six millimeter overjet.
Dr. Watkins recommended a treatment plan involving an upper
biteplate with orthodontic appliances and therapeutic non-
extraction with possible future extractions. Prior to initiating
treatment, Dr. Watkins used as diagnostic tools a panorex
radiograph, a cephalometric radiograph, trimmed study models, and
a facial analysis but did not take any intraoral or facial
photographs. According to Dr. Watkins, photographs are not
necessary to properly diagnose a patient as they do not show
anything that cannot be observed with the naked eye or that is not
recorded by the facial analysis. In addition, photographs are not
as useful as the three-dimensional trimmed study models or the
radiographs which not only show the patients' teeth but also his
jaw.
On 14 August 1997, Dr. Watkins placed Naico's orthodontic
appliances.
Since Naico did not progress as planned
, Dr. Watkins
considered possible extractions and surgery in May 1999. Dr.
Watkins, however, did not pursue the possibility of surgery because
there are very few oral surgeons in Greensboro and surgery would
likely require travel to Chapel Hill. Thus, Dr. Watkins preferred
to work out a plan that was reasonable for the patient unless
surgery was needed without a doubt. Since Naico's jaw was not
yet fully developed, Dr. Watkins wanted to observe the development
over the next year before reconsidering surgery. Dr. Watkins
treated Naico for a period of approximately two years until Naico
switched orthodontists. Dr. James Dudley Kaley, also an orthodontist, testified as the
Board's expert witness. According to Dr. Kaley, Naico's case was
not an average case to treat but an extremely difficult and
involved one. Because it involved a skeletal problem, Dr. Kaley
would have treated Naico through a combination of braces and
surgery. Surgery, however, would not be an option until after
Naico's jaw had matured between the age of sixteen and twenty-one.
Dr. Kaley considered surgery his number one treatment choice.
The second best would be a non-surgical treatment plan involving
the use of a Herbst appliance along with braces to correct Naico's
overbite. Dr. Kaley stated that failure to follow his treatment
suggestions would violate the standard of care. Dr. Kaley further
testified Dr. Watkins' treatment of Naico was inappropriate in that
it failed to correct the patient's orthodontic problems in a timely
manner, which Dr. Kaley's treatment plans would have, and that this
violated the standard of care. With respect to a non-surgical
treatment plan, Dr. Kaley testified it would probably take [him]
a good two and a half years minimum.
Dr. Kaley also testified Dr. Watkins violated the standard of
care by failing to take any intraoral and facial photographs prior
to initiating Naico's treatment plan. Dr. Kaley expressed the
opinion that such photographs are needed for proper diagnosis
because he, at least, diagnoses patients in his office based on his
records as opposed to when they sit in the chair in front of him.
He offered no testimony as to the comparative value of photographs
to the other diagnostic tools employed by Dr. Watkins. Dr. Kaleyfurther stated had he been given photographs, he could have made a
more accurate diagnosis of Naico when he evaluated him at the
Board's request. When asked during cross-examination how he
determined the standard of care for orthodontists with respect to
intraoral photographs, Dr. Kaley replied: my opinion [comes] from
meeting many people, . . . that is the standard of care that
everybody I know uses. Dr. Kaley did, however, concede that a
leading treatise in the field of dentistry does not list intraoral
photographs as among the minimal diagnostic records to be kept by
dentists or orthodontists.
During cross-examination, Dr. Kaley acknowledged that
different orthodontists will have differing opinions on the proper
treatment of a patient. With respect to his two proposed treatment
plans for Naico, Dr. Kaley explained: I didn't say it was the
only way. I said it was my way. He also testified that the
standard of care is determined [i]n retrospect, depending on the
way [the case] turned out.
The Board found as fact that:
17. [Dr. Watkins] failed to take, or have
available, intraoral or facial photographs
prior to initiating orthodontic treatment for
. . . Naico.
18. The standard for dentists licensed to
practice dentistry in North Carolina at the
time [Dr. Watkins] treated . . . Naico
required an orthodontist to take, or have
available, intraoral and facial photographs
prior to initiating orthodontic treatment.
19. [Dr. Watkins] violated the standard
of care for dentists licensed to practice
dentistry in North Carolina by failing totake, or have available, introral and facial
photographs prior to initiating orthodontic
treatment of . . . Naico.
20. [Dr. Watkins] placed . . . Naico's
appliances on August 14, 1997. [Dr. Watkins]
continued . . . Naico in orthodontics for the
following two years with routine adjustments.
21. [Dr. Watkins'] orthodontic treatment
for . . . Naico was inappropriate in that it
failed to correct his orthodontic problems
within a timely manner.
22. The standard of care for dentists
licensed to practice dentistry in North
Carolina at the time [Dr. Watkins] treated
. . . Naico required an orthodontist to
formulate an appropriate treatment plan to
remedy the problems diagnosed in a timely
manner.
23. [Dr. Watkins] violated the standard
of care for dentists licensed to practice
dentistry in North Carolina by failing to
formulate an appropriate treatment plan to
remedy the problems diagnosed in a timely
manner.
The Board then concluded Dr. Watkins' failure to comply with the
applicable standard of care in his treatment of . . . Naico . . .
was a dereliction from professional duty constituting negligence in
the practice of dentistry within the meaning of G.S. § 90-
41(a)(12).
As a result of its conclusions, the Board suspended Dr.
Watkins' dental license. Dr. Watkins appealed the suspension to
the trial court, which, in an order dated 5 April 2002, reversed
the Board's decision based on a lack of competent evidence as to
all three patients.
____________________________
The issues are whether: (I) Dr. Watkins' refusal to treat
Wolfe without payment falls within the purview of N.C. Gen. Stat.
§ 90-41(a)(12); (II) the testimony of Drs. Trentini and Kaley was
sufficient to establish the applicable standard of care and breach
thereof; and (III) if not, the Board was empowered to decide on its
own the standard of care for orthodontists and the type of conduct
constituting a breach of that standard.
In reviewing a superior court order examining an agency
decision, an appellate court must, depending on the issues raised
on appeal, determine whether the agency decision
(1) violated constitutional provisions; (2)
was in excess of the statutory authority or
jurisdiction of the agency; (3) was made upon
unlawful procedure; (4) was affected by other
error of law; (5) was unsupported by
substantial admissible evidence in view of the
entire record; or (6) was arbitrary,
capricious, or an abuse of discretion.
Shackleford-Moten v. Lenoir Cty., --- N.C. App. ---, ---, 573
S.E.2d 767, 770 (2002) (citing N.C.G.S. § 150B-51(b) (2001)).
Questions of law receive
de novo review, while issues such as
sufficiency of the evidence to support [an agency's] decision are
reviewed under the whole-record test.
In re Greens of Pine Glen
Ltd. Part., 356 N.C. 642, 647, 576 S.E.2d 316, --- (2003). Under
a
de novo review, the court considers the matter anew and freely
substitutes its own judgment for that of the agency.
Mann Media,
Inc. v. Randolph Cty. Planning Bd., 356 N.C. 1, 13, 565 S.E.2d 9,
17 (2002). The whole-record test, on the other hand, requires the
reviewing court to merely determine 'whether an administrativedecision has a rational basis in the evidence.'
In re McElwee,
304 N.C. 68, 87, 283 S.E.2d 115, 127 (1981) (quoting
In re Rogers,
297 N.C. 48, 65, 253 S.E.2d 912, 922 (1979)). The whole-record
test thus consists of an examination of all competent evidence
(the 'whole record') in order to determine whether the agency
decision is supported by 'substantial evidence.'
Amanini v. N.C.
Dep't of Human Resources, 114 N.C. App. 668, 674, 443 S.E.2d 114,
118 (1994).
I
In his brief to this Court and during oral arguments, Dr.
Watkins advocated that an orthodontist's rescheduling practices are
governed by N.C. Gen. Stat. § 90-41(a)(26), which speaks to
unprofessional conduct, and do not present a question of negligence
under section 90-41(a)(12) as concluded by the Board. Dr. Watkins
thus contends the Board made an error of law, reviewable
de novo.
Section 90-41(a)(12) allows the Board to revoke or suspend a
dentist's licence if he [h]as been negligent in the practice of
dentistry. N.C.G.S. § 90-41(a)(12) (2001). Subsection (a)(26),
on the other hand, applies if the dentist, or orthodontist in this
case, [h]as engaged in any unprofessional conduct as the same may
be, from time to time, defined by the rules and regulations of the
Board.
(See footnote 1)
N.C.G.S. § 90-41(a)(26) (2001). We agree with Dr.
Watkins that rescheduling matters of the sort that occurred inWolfe's case do not involve the practice of dentistry.
See
N.C.G.S. § 90-41(a)(12). Instead, if questionable behavior arises
in this context, it is more appropriately viewed as unprofessional
conduct, which is defined as [b]ehavior that is immoral,
unethical, or dishonorable, either generally or when judged by the
standards of the actor's profession.
Black's Law Dictionary 292
(7th ed. 1999). We further note that even if section 90-41(a)(12)
applied to the facts of this case as they pertain to Wolfe, there
would be no violation of the standard testified to by Dr. Cobb,
which illustrated the proper method of treating and discharging a
patient of record. According to Wolfe's own complaint, she had
terminated Dr. Watkins' services several months before the alleged
incidents. Thus, at the time Dr. Watkins rescheduled her due to
non-payment, she was no longer a patient of record. For these
reasons, the Board erred in concluding Dr. Watkins' failure to
treat Wolfe due to non-payment amounted to negligence under section
90-41(a)(12).
II
[P]rior to invoking disciplinary measures as authorized under
G.S. § 90-41(a), the Board must first be satisfied that the care
provided by the licensee was not in accordance with . . . a uniform
statewide minimum level of competency among . . . licensees.
In
re Dailey v. Board of Dental Exam'rs, 309 N.C. 710, 723, 309 S.E.2d
219, 226 (1983). In this case, the Board found Dr. Watkins had
breached the standard of care for orthodontists because his
treatment of both Casto and Naico was inappropriate in that itfailed to [address or] correct [their] orthodontic problems within
a timely manner. With respect to Naico, the Board also found that
failure to take any intraoral and facial photographs violated the
standard of care.
Having reviewed the whole record, we note that Dr. Trentini's
testimony only established that Dr. Watkins' treatment of Casto was
behind schedule. There was no testimony that the delay in schedule
was so great as to violate the statewide minimum level of
competency required of Board licensees.
Id. Furthermore, the
evidence presented at the hearing did not show that any delay in
treatment was Dr. Watkins' fault. Rather, the delay was the result
of excessive appliance breakage due to either patient noncompliance
or a faulty product, and there is no evidence Dr. Watkins failed to
repair Casto's broken brackets as soon as his patient schedule
permitted. Accordingly, there was no competent evidence to support
the Board's finding that Dr. Watkins had breached the standard of
care for orthodontists by failing to timely address Casto's
orthodontic needs.
See Amanini, 114 N.C. App. at 674, 443 S.E.2d
at 118 (review of all competent evidence must show the agency
decision is supported by 'substantial evidence').
The evidence with respect to Naico's treatment also failed to
support the Board's findings. Dr. Kaley testified to what he
believed to be the applicable standard of care and concluded Dr.
Watkins had breached this standard by pursuing the treatment plan
that he had, thereby failing to correct Naico's orthodontic
problems in a timely manner. A closer review of his testimony,however, reveals Dr. Kaley did not testify as to the
minimum level
of competency required of a licensee but merely gave his opinion on
the top two treatment plans he would have chosen for Naico. Dr.
Kaley even acknowledged during cross-examination that his choices
did not represent the only acceptable treatment methods; they
represented [his] way. Thus, there was no evidence presented as
to the applicable standard of care for orthodontists to support a
finding that Dr. Watkins' treatment plan for Naico was
inappropriate in that it failed to correct his orthodontic problems
within a timely manner.
See id.
While Dr. Kaley also testified that Dr. Watkins breached the
standard of care for orthodontists by failing to take intraoral and
facial photographs, there is absolutely no evidence in the record
to determine how the lack of such photographs would inhibit an
orthodontists' competence to properly diagnose a patient. Dr.
Watkins indicated he had used all the diagnostic tools listed in a
leading treatise on orthodontic care and that those tools were
superior to intraoral and facial photographs for purposes of proper
diagnosis. Dr. Kaley simply testified photographs would have
helped him better diagnose Naico when he evaluated him for the
Board and that, generally, they help him diagnose patients only
because he prefers to make his diagnosis in his office as opposed
to while the patient is sitting in front of him. Dr. Kaley did not
explain though what diagnostic value photographs have in contrast
to the radiographs, trimmed study models, and facial analysis taken
and reviewed by Dr. Watkins. As such, Dr. Kaley's testimony failedto establish that intraoral and facial photographs are required as
part of the statewide minimum level of competency required of
orthodontists.
See Dailey, 309 N.C. at 723, 309 S.E.2d at 226.
III
The Board argues that even if its experts' testimony was
insufficient on the standard of care for orthodontists or what
constitutes a breach thereof, the Board was empowered pursuant to
Leahy v. N.C. Bd. of Nursing, 346 N.C. 775, 488 S.E.2d 245 (1997)
to decide these issues based on its own expertise. Finding
Leahy
to be distinguishable in this case, we disagree.
In
Leahy our Supreme Court held:
Article 3A of the Administrative
Procedure Act, chapter 150B of the North
Carolina General Statutes, governs
disciplinary hearings by professional
licensing boards. N.C.G.S. § 150B-41(d)
provides in part, An agency may use its
experience, technical competence, and
specialized knowledge in the evaluation of
evidence presented to it. N.C.G.S. §
150B-41(d) (1995). The knowledge of the Board
includes knowledge of the standard of care for
nurses. The Board currently consists of nine
registered nurses, four licensed practical
nurses, one retired doctor, and one lay
person. The Board is authorized to develop
rules and regulations to govern medical acts
by registered nurses. N.C.G.S. §
90-171.23(b)(14) (1993). It is empowered to
administer, interpret, and enforce the Nursing
Practice Act. N.C.G.S. § 90-171.23(b)(1),
(2), (3), (7). The Board is required to adopt
standards regarding qualifications of
applicants for licensure and to establish
criteria which must be met by an applicant in
order to receive a license. N.C.G.S. §
90-171.30 (1993). To meet these requirements,
the Board must know the standard of care for
registered nurses in this state. There is no
reason it should not be allowed to apply thisstandard if no evidence of it is introduced.
Id. at 780-81, 488 S.E.2d at 248.
The rationale for allowing the Board of Nursing in
Leahy to
determine the standard of care based on its own expertise is not
transferrable to the case
sub judice. The Board of Nursing in
Leahy consisted almost entirely of nurses.
See id. In this case,
not only were none of the Board members orthodontists, but there is
also no separate licensing requirement for orthodontists in this
State. Thus, whereas all orthodontists in North Carolina are
trained in dentistry by virtue of the dental licensing requirement,
not all dentists are trained in orthodontics. Dentists care for
and remove teeth;
orthodontists focus on the movement of teeth with
the help of appliances.
See Webster's Third New International
Directory 603, 1594 (1968)
. Accordingly, it cannot be said that
the Board, whose members only practiced dentistry, had the
expertise to determine the standard of care for orthodontists
without any expert orthodontist testimony on the timely movement of
teeth. In light of the Board's composition in this case and the
insufficient testimony of orthodontists Drs. Trentini and Kaley on
the proper standard of care and breach thereof, we therefore affirm
the trial court's reversal of the Board's decision.
Affirmed.
Judge ELMORE concurs.
Judge HUNTER dissents.
============================
HUNTER, Judge, dissenting.
I respectfully dissent from the majority's opinion which
affirms the trial court's decision to reverse the Board's
suspension of Dr. Watkins' dental license.
I find the Board's ability to determine the standard of care
for orthodontists to be critical when addressing the remaining
issues discussed by the majority. With respect to this issue, the
majority holds that the Board did not have the expertise to
determine the standard of care for orthodontists or what
constitutes a breach thereof. The majority reached its holding by
distinguishing Leahy v. N.C. Bd. of Nursing, 346 N.C. 775, 488
S.E.2d 245 (1997), from the present case. However, this
distinction is flawed due to the majority interpreting Leahy too
narrowly.
In Leahy, our Supreme Court concluded that a North Carolina
Board of Nursing that consisted of, among others, nine registered
nurses, could properly revoke the license of another registered
nurse in the absence of expert testimony defining the standard of
care for a registered nurse because that board governs medical acts
by registered nurses. Here, the majority holds that since the
Board neither consisted of any orthodontists nor heard sufficient
expert testimony from an orthodontist defining the applicable
standard of care, the Board did not have the expertise to determine
the standard of care for orthodontists. However, the majority
fails to recognize that the Leahy Court also concluded as it did
because there was evidence in the record which the Board . . .use[d] its expertise to interpret, including its expertise as to
whether the petitioner had violated the standard of care for
registered nurses. From the record, [the Leahy Court was] able to
determine the validity of the Board's action. Id. at 780, 488
S.E.2d at 248.
In the case sub judice, even though there were no
orthodontists on the Board and, assuming arguendo, insufficient
expert testimony establishing the standard of care for
orthodontists, the Board (which consisted of all dentists) was
entitled to use its experience, technical competence, and
specialized knowledge to interpret the evidence that was presented
to it in order to determine the requisite standard of care. See
id. See also N.C. Gen. Stat. § 150B-41(d) (2001). This evidence
included, inter alia, patients' records, testimony from those
patients, and testimony from experts in the field of orthodontics
regarding the quality of care (or lack thereof) Dr. Watkins
provided to those patients. Specifically, with respect to each
patient, the evidence and my assessment of that evidence in light
of Leahy is as follows:
Sabrina Wolfe
There was uncontroverted evidence that Dr. Watkins rescheduled
two of Wolfe's appointments because of non-payment and before
receiving notification that she had found another orthodontist to
continue her treatment. Dr. Cobb testified that due to the
irreversible nature of an orthodontic program, an orthodontist
violates the standard of care when he refuses to see a patient thathas an outstanding account balance. He further supported this
testimony by referencing guidelines established by the American
Association of Orthodontists which detailed how to properly dismiss
a patient. He testified that those guidelines require that in the
event there's nonpayment of a fee, you have to give [the patient]
the opportunity to find another orthodontist and you have to be
agreeable to transfer the case, you have to provide emergency care
during that period of time. The majority concludes that despite
this evidence, rescheduling practices are more appropriately
viewed as unprofessional conduct instead of a violation of the
standard of care. Yet, as the reviewing court, we are only to
determine whether the Board's decision had a rational basis in
evidence. See In re McElwee, 304 N.C. 68, 87, 283 S.E.2d 115, 127
(1981). With that in mind, I note that standard of care is very
generally defined as the degree of care that a reasonable person
should exercise. Black's Law Dictionary 1413 (7th ed. 1999).
Even under this general definition, I believe that the evidence
presented to the Board establishes that a reasonable orthodontist
would not have refused treatment to Wolfe for non-payment after
having initiated an irreversible orthodontic program.
Additionally, the majority concludes that Wolfe was no longer a
patient of record since Wolfe's complaint alleged that she had
terminated Dr. Watkins' services prior to his refusal to treat her
due to an outstanding account balance. However, the Board did not
make that finding. The evidence actually established that even if
Wolfe believed she had terminated Dr. Watkins' services, shecontinued to be in need of and request those services to address
problems related to her orthodontic program because she had yet to
find another orthodontist or be formally dismissed by Dr. Watkins.
Thus, when the Board interpreted the evidence in light of its
experience, technical competence, and specialized knowledge, the
Board had a rational basis to conclude that Dr. Watkins'
rescheduling practices violated the applicable standard of care
thereby resulting in negligence.
John Matt Casto
Casto's patient records were offered into evidence and
detailed the orthodontic treatment he had received while under Dr.
Watkins' care for over two years. Additional evidence indicated
that Dr. Watkins alleged his treatment of Casto was behind schedule
due to the child's poor compliance with treatment instructions.
Dr. Trentini testified that it was apparent Casto had not been
practicing proper dental hygiene when the child first visited him
after ending treatment with Dr. Watkins and that failure to do so
could prolong treatment. Nevertheless, Dr. Trentini still opined
that the child's progress was behind schedule and that he would not
have treated Casto as Dr. Watkins did. When faced with conflicting
evidence, the Board is responsible for determining the credibility
of witnesses and resolving conflicts in their testimony. In re
Braun, 352 N.C. 327, 332, 531 S.E.2d 213, 217 (2000). Therefore,
the Board was entitled to use its experience and expertise to
interpret the evidence and the patient records to ultimately
conclude Dr. Watkins' treatment plan for Casto breached thestandard of care by failing to timely address Casto's orthodontic
needs.
Harry Conrad Naico
With respect to Naico, his original diagnostic records
compiled by Dr. Watkins were also presented into evidence. Dr.
Kaley observed these records and personally evaluated Naico. On
direct examination, Dr. Kaley admitted that Naico's case was
extremely difficult to correct and that the child may have been
non-compliant with treatment instructions. Despite these problems
however, he opined that Dr. Watkins violated the standard of care
for orthodontists by failing to adequately diagnose and formulate
an appropriate treatment plan to correct Naico's orthodontic
condition in a timely manner. Dr. Kaley based his opinion on Dr.
Watkins' (1) failure to have adequate treatment records, (2) poor
quality models, and (3) not presenting surgery as an option to
Naico at the outset to correct Naico's orthodontic problems.
Further, Dr. Kaley testified that he did not believe the treatment
plan Dr. Watkins had developed for Naico would have addressed the
child's orthodontic needs regardless of time.
Additionally, Dr. Kaley testified Dr. Watkins' failure to take
intraoral or facial photographs violated the standard of care for
orthodontists. He testified that all other dentists he knew used
intraoral photographs. He further testified that between 1996 and
1999, licensed dentists in North Carolina were required to take
such photographs prior to initiating orthodontic treatment. On
cross-examination, Dr. Kaley conceded that there was a learnedtreatise that did not indicate intraoral and facial photographs
were necessary for minimal diagnostic records for an orthodontic
patient. Nevertheless, as stated earlier, the Board and not this
Court is responsible for resolving such a conflict. See id.
Accordingly, the Board's experience, technical competence, and
specialized knowledge allowed that governing body to interpret the
evidence presented regarding Dr. Watkins' treatment of Naico and
determine that Dr. Watkins violated the standard of care by failing
to (1) develop an appropriate treatment plan to timely address
Naico's orthodontic needs, and (2) take the necessary photographs
prior to initiating that plan.
Finally, despite the Board consisting of all dentists and no
orthodontists, it still possessed the necessary expertise to
determine the standard of care for orthodontists. Our Supreme
Court has recognized that [t]he North Carolina State Board of
Dental Examiners, like all other professional licensing boards, was
created to establish and enforce a uniform statewide minimum level
of competency among its licensees. In re Dailey v. Board of
Dental Examiners, 309 N.C. 710, 723, 309 S.E.2d 219, 226 (1983).
Orthodontists, each of whom are trained in dentistry and have a
dental license, also have their level of competency governed by
this Board especially since there are no separate licensing
requirements for orthodontists in this state. Therefore, under
Leahy the Board was empowered to decide the standard of care for
orthodontists and which type of conduct constitutes a breach of
that standard. In conclusion, I believe this Court is able to determine the
validity of the Board's decision to suspend Dr. Watkins' dental
license based upon the evidence in the record. Thus, for the
aforementioned reasons, I would reverse the trial court's decision.
Footnote: 1