STATE OF
BEFORE THE DENTISTRY EXAMINING BOARD
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IN THE MATTER OF
DISCIPLINARY :
PROCEEDINGS
AGAINST
:
FINAL DECISION
:
AND ORDER
PETER HEHLI, D.D.S.,
:
LS0404271DEN
RESPONDENT.
:
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Division of Enforcement Case No. 03DEN059, 00DEN003
The State of
ORDER
NOW, THEREFORE, it is hereby ordered that the Proposed Decision annexed hereto,
filed by the Administrative Law Judge, shall be and hereby is made and ordered
the Final Decision of the State of
The rights of a party aggrieved by this Decision to petition the department for
rehearing and the petition for judicial review are set forth on the attached
"Notice of Appeal Information."
Dated this 2nd day of November, 2005.
Nanette K Dreves
Member of the Board
Dentistry Examining Board
STATE OF
BEFORE THE DENTISTRY EXAMINING
BOARD
IN THE MATTER OF
DISCIPLINARY PROCEEDINGS
AGAINST PROPOSED
FINAL DECISION
AND ORDER
PETER HEHLI,
DDS,
Case No. LS0404271DEN
Respondent.
______________________________________________________________________________
(Division of Enforcement Case File Nos. 03 DEN059, 00DEN003)
For purposes of review under Wis. Stat. § 227.53, the parties in
this matter under Wis. Stat. § 227.44 and
Peter Hehli, DDS
W. Patrick Sullivan (Attorney for Respondent)
Division of Enforcement
James E. Polewski (Attorney for Complainant)
Department of Regulation and Licensing
Department of Regulation and Licensing
PROCEDURAL HISTORY
This case was initiated by the filing of complaint dated
FINDINGS OF FACT
1. Peter D. Hehli, D.D.S (“Respondent”) was born on
2. Between April 1991
and March 1999, Respondent was the general dentist for patient EVD, a female
born
3. Patient EVD was
also the patient of Dr. Karen Wedde, an orthodontist.
4. Dr. Wedde treated Patient EVD for malocclusion, with the
additional goal of maintaining space for an implant or pontic
for tooth #10, which was congenitally missing from Patient EVD.
5. On
6. At the time, the
patient and her parents believed that Respondent was performing the necessary
work for a bonded bridge, which would allow the patient to complete her growth
and maintain a space for future implant of a prosthetic #10.
7. The actual
preparation for the permanent fixed porcelain bridge required substantial
modification of teeth #9 and #11, which were, at the time, virgin teeth.
8. The bridge which
Respondent designed and installed was less than minimally competent dental work
in that it had open margins, tissue impingement because of overcontouring,
bridge margins short of the prepared margins on teeth #9 and #11, and esthetic
errors of contour and shade.
9. Respondent did not
recognize the deficiencies of the bridge which he designed and installed until
after the patient and her parents had sought a second opinion of
Respondent’s assurances that the bridge was technically acceptable.
10. Respondent designed and
installed a second permanent fixed porcelain bridge.
11. Respondent treated Patient VH,
a female born
12. Respondent performed
endodontic treatment on ten teeth for Patient VH, using the Sargenti
method.
13. Respondent extracted tooth
number 29 on
14. Tooth number 28 required
endodontic therapy on
15. On
16. It was inappropriate to place a
bridge for tooth number 29 with only a single supporting abutment.
17. The use of Sargenti
technique and paste was below the minimally acceptable standard of practice for
endodontic treatment during the period Respondent was treating Patient VH.
18. During the pendency of this
proceeding, in consultation and cooperation with the Division of Enforcement
and at significant personal expense, Respondent has successfully completed 35
hours of continuing dental education in endodontics
in residence at the University of California Los Angeles, and 23 hours of
continuing dental education in prosthodontics
sponsored by the American College of Prosthodontists
in Chicago, Illinois.
CONCLUSIONS OF LAW
1. The Dentistry
Examining Board has jurisdiction in this matter pursuant to Wis. Stat. §.
447.07.
2. Respondent’s
treatment of Patient EVD with the first bridge constituted less than minimally
competent practice of prosthodontics in that it
altered teeth that could have been preserved by a bonded bridge, and in that
the first bridge was deficient in technical considerations, and in that there
was a lack of informed consent to the first bridge, all of which constitutes a
violation of Wis. Admin. Code § DE 5.02(5).
3. Respondent’s
treatment of Patient VH constituted a violation of Wis. Admin. Code s. DE
5.02(5) in the use of Sargenti technique and paste,
and in using only tooth number 28 as an abutment for a bridge replacing tooth
number 29.
ORDER
NOW, THEREFORE, IT IS ORDERED that the license of Peter Hehli, D.D.S., (lic. #4059) to practice dentistry in the
state of
IT IS FURTHER ORDERED that the license of Peter Hehli,
D.D.S., shall be, and hereby is, LIMITED. The limitation shall
permanently prohibit Dr. Hehli from using the Sargenti technique or paste in performing endodontic
treatment in his dental practice.
IT IS FURTHER ORDERED that Dr. Hehli shall
pay the COSTS incurred in this proceeding in the amount of $4,618.83.
IT IS FURTHER ORDERED that Dr. Hehli shall
pay a FORFEITURE in the amount of $500.00
dollars. Payment of the costs and forfeiture shall be submitted within 90
days from the date of this order. Payment shall be made by
certified check or money order, payable to the Wisconsin Department of
Regulation and Licensing and sent to:
Department Monitor
Divisions of Enforcement
Dept. of Regulation & Licensing,
IT IS FURTHER ORDERED that the Dentistry Board accepts the 35-hour Endodontic
Continuum Course held on August 12, 2004 through August 15, 2004 at the
University of California Los Angeles School of Dentistry and the 23-hour American
College of Prosthodontics’ Prosthodontist
Review Course held on November 18, 2004 through November 20, 2004 in
Chicago, Illinois, taken by Dr. Hehli prior to the
issuance of this order as appropriate continuing education to address his
deficiencies in practice and unprofessional conduct. The continuing
education taken by Dr. Hehli constitutes the type of
education and clinical training that the Board would otherwise have ordered him
to obtain. The courses were from American Dental Association (ADA)
accredited providers of continuing dental education.
OPINION
Applicable Laws
Analysis
From the onset and throughout the course of these proceedings, the
factual and legal allegations of unprofessional conduct have not been in
dispute. Prior to the filing of the formal complaint, Dr. Hehli and the Division of Enforcement entered into a
settlement stipulation, including agreed findings of fact and conclusions of
law, in an effort avoid holding a hearing. Pursuant to the stipulation,
Dr. Hehli agreed to take at his own expense,
continuing education courses that were recommended by the Division of
Enforcement in anticipation of the Board’s discipline.
Unfortunately, the parties’ stipulation did not make it to the Dentistry
Examining Board members.
At the beginning of the hearing the parties indicated that they were
still willing to cooperate in reaching a resolution and again stipulated to the
operative facts and violations of law. This cooperation significantly
reduced the time and expense that would have been required if the matters were
contested. As a result, the only issue left to be decided at the hearing
was whether, based upon the evidence received at the hearing, Dr. Hehli’s voluntary compliance with the Division of
Enforcement’s recommended discipline constitutes an appropriate
resolution of this matter.
The dental practices at issue in this case occurred approximately
6-1/2 years ago. In his testimony, Dr. Hehli
admitted that he made mistakes that many other young dentists could make or do
make; that it was a matter of judgment and being less experienced. Dr. Hehli further explained that the situation involving
patient EVD, and the placement of a permanent bridge, was in part due to a
patient-communication problem. Dr. Hehli
testified:
This involved a 14 year-old child who looked like she was 18 and was a
good patient of our practice for many, many years. And as the record
states, there were several interviews with the parents and specialists.
And when I did this first procedure, I thought it my mind that’s what the
patient and the parents wanted. In fact, the patient’s father was
in the room when I started the procedure. [Tr at pgs. 60-61.]
Dr. Hehli further testified that if he had
to do it over again now, he would not do that same type of bridge.
Instead, Dr. Hehli would offer the patient other
options such as dental implants. He further stated that he would not have
recommended an implant in 1997, but dentistry and dental technology and dental
science have changed a lot since then. Dr. Hehli’s
demeanor at the hearing showed a sincere recognition of his errors and an
understanding of his obligation to practice in competent manner.
With respect to the treatment of the second patient, Dr. Hehli was also candid and forthright in acknowledging his
deficiencies in treatment planning. Dr. Hehli
also explained that much like the first case, technology has changed so much
that the treatment options are now quite different. Dr. Hehli
admitted that the treatment planning was not commensurate with the standard of
care required in the dental profession.
As to the Sargenti technique, Dr. Hehli testified that it was a recognized treatment in 1998
and that he learned the technique from his father. He explained that it
was used at time when the technology was different and he worked in a managed
care practice. [Tr. at pg. 45]. Upon
further questioning, Dr. Hehli elaborated about the
technique and explained that it was practiced by a very small percentage of
dentists as compared to the American Association of Endodontics
who practice the gutta-percha method:
I guess that I mean
that there’s a small percentage of dentists - -
in fact they have their own group that practice the Sargenti
method, but it’s a very small minority. And if you asked a hundred
dentists, 99 of them would say that it’s not acceptable. [Tr. at
pg. 66]
Dr. Hehli’s view of the
efficacy of the Sargenti technique as an endodontic
treatment and his use of it has changed dramatically since this disciplinary
process began. He testified that he stopped using the Sargenti
method as soon as it was brought to his attention by the Division of
Enforcement and he signed the stipulation agreeing to discipline. [Tr. at pg. 45]. Dr. Hehli
also testified that he does not intend to ever use that technique in a root
canal procedure again. [Tr. at pg. 46] Throughout the course of the
hearing, Dr. Hehli demonstrated a remarkable level of
candor and acceptance of professional responsibility for his actions.
More importantly, the evidence submitted at the hearing supported Dr. Hehli’s contention that he has taken meaningful
action to improve his diagnostic and clinical technique in the areas of endodontics and prosthodontics.
In 2004, Dr. Hehli took an
Dr. Ko testified
that her program teaches to the standard of care as established by the American
Association of Endodontics; that the goal of the
program is to make general dentist more proficient in doing root canal
treatment, but not to make them endodontists.
[Tr. at pg. 39] Dr. Ko
further explained that the UCLA course teaches the current technique for
filling the root canal system, how to pick the appropriate length and size of
the filling materials, proper working length and biomechanical preparation,
disinfection, and mixing of agents and solutions. [Tr. at pg.
29-32]. Dr. Ko
testified that she had a personal opportunity to work with Dr. Hehli. In her opinion, Dr. Hehli
exhibited a keen interest and willingness to increase his knowledge and improve
his skills; asking detailed questions and showing that he was eager to apply
his training. Dr. Ko
testified:
Dr. Hehli stands out in the class. He
asked very good questions. And that I remember. And in the
laboratory he’s always next to me showing me what he’s done, how to
critique, how to cement, how to do a better, you know, root canal
treatment. And I like when the dentists are very inquisitive and like to
prove themselves; especially in a course like this
when there’s so much to learn.” [Tr. at 37]
In November 2004, Dr. Hehli also completed a
twenty-three hour Prosthodontics Review Course
offered by the
The substantial coursework which Dr. Hehli
has taken in endodontics and prosthodontics
should be considered sufficient to address and remedy the errors of judgment or
deficits in technique that he made over six years ago when he was relatively
new in his practice. No further continuing education is necessary.
This result is consistent with the Board order in the Zollya
Geller, DDS, (May 2004) where Dr. Geller completed a week long course at an
similar circumstances. James Michaels, DDS
(May 2005); John Syverson, DDS (November 2004)
and Eugene Weber, DDS (January 2004). Although it is generally
preferable for a respondent to await the final decision of a Board before
taking continuing education, there is substantial value to the public when such
education occurs earlier rather than later as a respondent can make changes in
his practice and avoid making the same mistakes with other patients.
The overwhelming evidence received at the hearing supports the
conclusion that Dr. Hehli has exhibited a genuine
commitment to acquiring and or improving his knowledge and skills as a dentist,
particularly in the area of endodontics and
prosthetics. It is also reasonable to conclude that Dr. Hehli is now a competent practitioner in these areas given
the additional education and training which he has taken. Dr. Hehli has been an associate member of the American
Association of Endodontists since April 16, 2004. [Res. Exhibit 1] Additionally, in August
2004, Dr. Hehli was appointed by the
The recommendation that Dr. Hehli receive a
reprimand for his conduct in this case is consistent with the objectives of
professional discipline to promote the rehabilitation of the licensee, to
protect the public; and to deter other licensees from engaging in similar
conduct. State v. Aldrich, 71
Costs and Forfeiture
Under the law, the Board has the discretion to impose all, some, or
none of the costs of the proceeding.
Respectfully submitted,
Dated this 29th day of September, 2005.
Colleen M. Baird
Administrative Law Judge