STATE OF FLORIDA BOARD OF DENTISTRY ADMINISTRATIVE COMPLAINT. undersigned counsel, and files this Administrative Complaint before the

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1 DEPARTMENT OF HEALTH, PETITIONER, STATE OF FLORIDA BOARD OF DENTISTRY v. CASE NO.: MICHAEL SAMPSON, D.M.D., RESPONDENT. ADMINISTRATIVE COMPLAINT COMES NOW Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Dentistry against Respondent, Michael Sampson, D.M.D., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practice of dentistry pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 466, Florida Statutes. 2. At all times material to this Complaint, Respondent was a licensed dentist within the State of Florida, having been issued license number DN Respondent's address of record is 1779 South Pinellas Avenue, Suite 100, Tarpon Springs, Florida

2 4. On or about February 13, 2012, Respondent entered into a five-year contract with the Professionals Resource Network ("PRN"). 5. On or about December 19, 2016, PRN determined that his exit from monitoring could not be granted as Respondent had not secured fulltime employment, and as a result, had not undergone the required neuropsychological and polygraph testing. Subsequently, the contract was extended for an indeterminate length to allow for Respondent to practice under monitoring for one year and to have a Readiness for Exit Evaluation. 6. On or about February 6, 2018, Respondent requested PRN to allow him to exit from monitoring without an evaluation for financial reasons. PRN reviewed his file and determined that an update from Respondent's treating physician regarding his current health and neurological status, was necessary. 7. Additionally, PRN agreed to allow Respondent an outpatient evaluation with Neurocognitive Testing. 8. On or about March 2, 2018, Respondent submitted to an evaluation by a PRN approved evaluator

3 9. It was determined, likely due to a major vascular neurocognitive disorder, Respondent is not considered able to practice independently with reasonable skill and safety. 10. Respondent is not able to practice in a solo private setting given his need for supervision as demonstrated by his cognitive disorder. 11. Respondent did not agree with the recommendations of his evaluation and would not refrain from his solo practice. 12. Respondent is practicing in a solo practice setting in violation of his PRN directives. 13. On or about May 10, 2018, PRN terminated Respondent's contract because Respondent is not safe for solo practice, but is nonetheless engaged in solo practice. 14. Section (1)(hh), Florida Statutes (2017), states that being terminated from an impaired practitioner program that is overseen by a consultant as described in Section , Florida Statutes, for failure to comply, without good cause, with the terms of the monitoring or participant contract entered into by the licensee, or for not successfully completing any drug treatment or alcohol treatment program is grounds for discipline by the Board of Dentistry

4 15. Respondent violated Section (1)(hh), Florida Statutes (2017) by being terminated without good cause from a PRN contract. 16. Based on the above, Respondent violated (1)(hh), Florida Statutes (2017), and is therefore subject to discipline. WHEREFORE, Petitioner respectfully requests that the Board of Dentistry enter an order imposing one or more of the following penalties: imposition of an administrative fine, issuance of a reprimand, placement of Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. [Signature block on next page]

5 SIGNED this day of No letia 1)-e Celeste Philip, M.D., M.P.H. Surgeon Genera nd Secretary FILED DEPARTMENT OF HEALTH DEPUTY CLERK CLERK Angel Sanders DATE NOV Ga S riel A. GI o Assistant General Counsel Florida Bar # DOH-Prosecution Services Unit 4052 Bald Cypress Way-Bin C-65 Tallahassee, Florida (850) (850) fax Gabriel.girado@flhealth.gov PCP: November 2, 2018 PCP Members: Daniel Gesek, D.M.D.; Carl Melzer, D.D.S.; and Claudio Miro, D.D.S

6 NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section and , Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. A request or petition for an administrative hearing must be in writing and must be received by the Department within 21 days from the day Respondent received the Administrative Complaint, pursuant to Rule (2), Florida Administrative Code. If Respondent fails to request a hearing within 21 days of receipt of this Administrative Complaint, Respondent waives the right to request a hearing on the facts alleged in this Administrative Complaint pursuant to Rule (4), Florida Administrative Code. Any request for an administrative proceeding to challenge or contest the material facts or charges contained in the Administrative Complaint must conform to Rule (5), Florida Administrative Code. Please be advised that mediation under Section , Florida Statutes, is not available for administrative disputes involving this agency action. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section (4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed