STATE OF FLORIDA THE FLORIDA BOARD OF DENTISTRY

STATE OF FLORIDA THE FLORIDA BOARD OF DENTISTRY Final Order No. DOH-17-2170- By: FILED DATE - Depart ent of Health rionnf, A anrso Merle -MQA DEC 0 4,,Ao Cotv DEPARTMENT OF HEALTH, PETITIONER, VS. CASE NOS.: 2017-00367 2016-21584 JUSTIN A. MARTONE, D.M.D., RESPONDENT. LICENSE NO.: DN 18184 FINAL ORDER SETTLEMENT AGREEMENT This matter appeared before the Board of Dentistry (hereinafter Board) at a duly-noticed public meeting on November 17, 2017, in Kissimmee, Florida, pursuant to Sections 120.569 and 120.57(4), Florida Statutes, for consideration of a Settlement Agreement. Upon consideration of the Settlement Agreement, the documents submitted in support thereof, the arguments of the parties and otherwise being advised in the premises, it is hereby ORDERED AND ADJUDGED that: 1. The settlement agreement be and is hereby approved, adopted, and incorporated by reference herein. Accordingly, the parties shall adhere to and abide by the terms and conditions of the settlement agreement. 2. The Costs of investigation and prosecution are $3,000.00. THIS ORDER SHALL TAKE EFFECT UPON BEING FILED WITH THE CLERK OF THE DEPARTMENT OF HEALTH.

-4( DONE AND ORDERED this 1 day of \ etenlbec-, 2017. BOARD OF DENTISTRY Jennifer L. Venhold, MSW, Executive Director on behalf o Catherine Cabanzon, RDH Chair of the Board of Dentistry

CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by US Mail to Justin A. Martone, D.M.D., 11957 Sandlake Drive, Boca Raton, Florida 33428 ; and via Electronic Mail to John Wilson, Assistant General Counsel, john.wilson@flhealth.gov; and to David D. Flynn, Assistant Attorney General, david.flynn@myfloridalegal.com this tt: day of 2017. ACY 696311 DEPUTY AGEN Y CLERK

1823 DEPARTMENT OF HEALTH, STATE OF FLORIDA BOARD OF DENTISTRY v. Petitioner, JUSTIN A. MARTONE, CASE NO. 2016-21584 2017-00367 Respondent. SABALSEMEMEMELGRUMER Pursuant to Section 120,57(4), Florida Statutes, the above-named parties hereby offer this Settlement Agreement (Agreement) to the Board of Dentistry (Board)' as disposition of the Administrative Complaint, in lieu of any other administrative proceedings. The terms herein become effective only if and when a Final Order accepting this Agreement is issued by the Board and filed with the Agency Clerk of the Department of Health (Department). In considering this Agreement, the Board may review all investigative materials regarding this case. If this Agreement is not accepted by the Board, the Agreement and its presentation to the Board shall not be used against either party, Page 1 Respondent Initiart\-)

1824 STIPULATED ma's 1. For all times pertinent herein, Respondent was a licensed dentist in the State of Florida, having been issued license number DN18184 on November 2, 2007. 2. Respondent Is currently located at 33 SE 8th Street, Apartment 405, Boca Raton, Florida 33432. 3. Respondent was charged by Administrative Complaints with violating: Sections 466.028(1)(n) and 466.028(1)(mm), Florida Statutes in Case No. 2016-21584; and Section 466.028(1)(m), Florida Statutes, in Case No. 2017-00367. The Administrative Complaints were filed by the Department and properly served upon Respondent. True and correct copies of the Administrative Complaints are attached hereto and incorporated by reference as Exhibits "A" and "B." 4. Respondent neither admits nor denies the factual allegations; in the Administrative Complaints and is entering into this Settlement Agreement for the purpose of settlement in these administrative proceedings only. For purposes of this Settlement Agreement, where terms of the Agreement require the Board to undertake action or grant approval, the Board can appoint a representative or designee to act In its stead. In light of this, references to the "Board" can also refer to the Board's designee. Page 2 Respondent In

1825 STIPULATED LAW 1. Respondent admits that Respondent is subject to the provisions of Chapters 456 and 466, Florida Statutes, and the jurisdiction of the Department and the Board. 2. Respondent admits that the stipulated facts, if proven true, constitute violations of Florida laws as alleged in the Administrative Complaint. 3. Respondent admits that the Settlement Agreement is a fair, appropriate, and reasonable resolution to these pending matters. Egg/POSE PISPOSITIQN 1. ARegABALKE: Respondent shall be present when this Settlement Agreement is presented by the Department to the Board, arid, under oath, Respondent shall answer the questions posed by the Board concerning these cases and the disposition thereof. 2. REPRIMAND: The Board shall reprimand the license of Respondent. 3. FINg: The Board shall impose an administrative fine of se_vgn t e hundred doilars nd no cents (17.500.00) against the license of Respondent. Respondent acknowledges that the timely payment of the fine is Respondent's legal obligation and responsibility. Respondent shall Page 3 Respondent InitialCV\

1826 pay the fine by either cashier check or money order made payable to the Board withi ne ;.. ro ef in of F t0 r iss - in matters. Respondent shall send payment(s) to: Florida Department of Health, Division of MQA/Client Services, P.O. Box 6320, Tallahassee, FL 32314-6320. 4. COSTS: Pursuant to Section 456.072(4), Florida Statutes, Respondent shall pay all actual costs associated with the investigation and prosecution of this matter. Actual costs will be determined at the time this Settlement Agreement is presented to the Board, but shall not exceed three thousand dollars and no cents ($3,000.00). Respondent shall pay all costs by either cashier check or money order made payable to the Board hin ear 0 I - Id the I II e rder ed in se matters. Respondent shall send payment(s) to: Florida Department of Health, Division of MQA/Client Services, P.O. Box 6320, Tallahassee, FL 32314-6320. 5. RECORWEEPIRG: Withinne omr of the Final Order, issued in these matters, Respondent shall complete a three-hour course in Recordkeeping. The course shall be taken through a Boardapproved continuing education provider. 6. JAWS & RULES EXAM: Within one year of the date of ithe Order lifting the suspension of Respondent's license to practice dentistry, if Page 4 Respondent initial

1827 any, Respondent shall pass the Laws & Rules Examination governing the practice of dentistry in the State of Florida. 7. sumaa_ala,aujungp_mgmr: Respondent understands that Respondent shall not serve as a "qualified monitor" until Respondent has complied with all of the obligations imposed by the Final Order adopting and incorporating this Agreement. Furthermore, if Respondent is serving as a "qualified monitor," at the time the Final Order in this case is filed, Respondent shall provide written notice of the Final Order and terminate all monitory relationships within one (1) day of the filing of the Final Order. WS)...WMIKALIMill: It is expressly understood that violating any of the terms of this Agreement shall be considered a violation of a Final Order of the Board, for which disciplinary action may be initiated pursuant to Chapters 456 and 466, Florida Statutes. 9. APPROVAX: It is expressly understood that this Agreement is subject to approval by the Board and has no force or effect until the Board adopts, incorporates or bases an Order, properly filed, upon it. Page 5 Respondent Inftiadli\-,

1828 PROCEEDINGS: Respondent executes this Agreement for the purpose of avoiding further administrative action with respect to this particular case. In this regard, Respondent authorizes the Board to review and examine all investigative file materials concerning Respondent prior to or in conjunction with consideration of this Agreement. Respondent agrees to support this Agreement at the time it is presented to the Board and shall offer no evidence, testimony, or argument that disputes or contravenes any stipulated fact or condusion of law. Furthermore, should the Board not accept this Agreement, the parties agree that the presentation and consideration of this Agreement and other documents and matters by the Board shall not unfairly or illegally prejudice the Board or any of its members from further participation, consideration or resolution of these proceedings. 11. ADDIUDIAL PROcgEDIfigs: Respondent and the Department fully understand that this Agreement and subsequent Final Order incorporating same, will in no way preclude additional proceedings by the Board andjor Department against the Respondent for acts or Page 6 Respondent Initial

1829 omissions not specifically set forth in the Administrative Complaint, attached as Exhibit "A," filed in this cause. 12. WAIVER OF ATTORAEY FEES: Respondent waives the right to seek attorney fees or costs from the Department in connection with this disciplinary proceeding. 13. WAIVER OF JUDICIAL REVIEW AND CHALLENGE: Upon the Board's adoption of this Agreement, Respondent expressly waives all further procedural steps, and expressly waives all rights to seek judicial review of or to otherwise challenge or contest the validity of this Agreement and the Final Order of the Board incorporating said Agreement. WHEREFORE, the parties hereby request the Board to enter a Final Order accepting and implementing the terms contained herein. SIGNED this 3 day of oe'fpto?-r $ 201 Justi 'artone, D.M.D. Case 2016-21584 2017-00367

1830 STATE OF FLORIDA COUNTY OF ivoaman, Before me personally appeared Ls-r+n 41-1246:5LIckc 4cv,e, whose identity is known to me by personal knowledge or by presentation of Ft t)od-trl r-e,v s--t. as identification (type of identification), and who acknowledges that their signature appears above. Sworn to or affirmed before me this 3rck day of Ocy ohet-, 20Y1. Notary Public toj t21_1-a tel My Commission Expires Slevin Ns& Nay Pubb OW rift* UNCOMMON #N Evkat Ocktor It, 2019 Page 8 Respondent Initial

1831 APPROVED this day of, 2011. Celeste Philip, M.D., M.P.H. Surgeon General and Secretary Octavio Simoes-Ponce Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar No. #0096511 850.558.9902 850.245.4684 FAX octavio.simoes-s ce@flhealth.gov / / RoSe GarilSon Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar No. #105920 850.558.9842 850245.4684 FAX rose.garrison@flhealth.gov Page 9 Respondent initial

2001 DEPARTMENT OF HEALTH, STATE OF FLORIDA DEPARTMENT OF HEALTH PETITIONER, v. CASE NO. 2016-21584 JUSTIN A. MARTONE, 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, Justin A. Martone, D.M.D., and in support thereof alleges: 1.. Petitioner is the state agency 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 Administrative Complaint, Respondent was a licensed dentist within the state of Florida, having been issued license number DN18184.

2002 3. Respondent's address of record is 514 North State Road 7, Suite B, Royal Palm Beach, Florida 33411. 4. An additional address for Respondent is 33 Southeast 8th Street, Apartment 405, Boca Raton, Florida 33432. 5. Another additional address for Respondent is 6910 Town Harbour Boulevard, Apartment 2719, Boca Raton, Florida 33433. 6. At all times material to this Administrative Complaint, Respondent was the owner and a dentist at Apple Tree Dental, located at 514 North State Road 7, Suite B, Royal Palm Beach, Florida 33411. 7. Patient D.O. is a former patient of Respondent's who was treated by Respondent from March 2012 through July 2016. 8. Patient D.O. had an appointment set for August 23, 2016, for dental care from Respondent. 9. Patient D.O. presented for her appointment but Apple Tree Dental was closed and Respondent was not present. 10. Respondent reported that he had mailed a notice to all active patients concerning the dental practice closure. 11. Patient D.O. did not receive any notice that Respondent closed his practice. Department of Health v. Justin A. Martone, D.M.D, 2 Case Number 2016-21584

2003 12. In or around June 2016, Respondent's dental practice closed indefinitely. 13. On or about September 7, 2016, Patient D.O. requested her Patient records by certified mail to the Respondent's place of practice and address of record with the Department of Health. 14. The certified receipt and mailed letter was returned to Patient D.O. as "Not Deliverable as addressed, unable to forward." 15. Respondent failed to provide Patient D.O. her patient records. 16. Respondent failed to follow the procedures outlined in Rule 64B5-17.001, Florida Administrative Code, for notifying patients of the termination of his dental practice where patients could obtain copies of records. 17. To date, Respondent has failed to provide written notification to the Department of his current mailing address. COUNT I: Failure to Provide Records 18. Petitioner re-alleges and incorporates paragraphs one through fifteen, as if fully set forth herein. 19. Section 466.028(1)(n), Florida Statutes (2016), states that failing to make available to a patient, or to her or his legal representative Department of Health v. Justin A. Marton, D.M.D. 3 Case Number 2016-21584

2004 or to the department if authorized in writing by the patient, copies of documents in the possession or under control of the licensee which relate to the patient, subjects an dentist to discipline, 20. As set forth above, Respondent failed to provide medical records upon request to patient D.O. 21. Based on the foregoing, Respondent violated Section 466.028(1)(n), Florida Statutes (2016), by failing to make available to a patient, or to her or his legal representative or to the department if authorized in writing by the patient, copies of documents in the possession or under control of the licensee which relate to the patient. COUNT II: Failure to Notify of Addre ian stgg 22. Petitioner re-alleges and incorporates paragraphs one through six, twelve, and seventeen as if fully set forth herein. 23. Section 466.028(1)(mm), Florida Statutes (2016), subjects an dentist to discipline by the Board of Dentistry for violating any provision of this chapter or chapter 456, or any rules adopted pursuant thereto. 24. Rule 64B5-17, The Florida Administrative Code (2016), sets out the dental practice and principles by which licensees are to abide. 25. Rule 64B5-17.0011, Florida Administrative Code (2016), Department of Health v. Justin A. Martone, D.M.D. 4 Case Number 2016-21584

2005 provides that all licensees are required to notify the Board in writing within 10 days of any change in their address. 26. As set forth above, Respondent failed to provide written notification to the department of the licensee's current mailing address. 27. Based on the foregoing, Respondent violated Section 466.028(1)(mm), Florida Statutes (2016), by violating Rule 64B5-17.0011, Florida Administrative Code (2016), by failing to provide written notification to the department of the Respondent's current mailing address. COUNT III: Notice of Termination 28. Petitioner re-alleges and incorporates paragraphs one through seventeen, as if fully set forth herein. 29. Section 466.028(1)(mm), Florida Statutes (2016), subjects an dentist to discipline by the Board of Dentistry for violating any provision of this chapter or chapter 456, or any rules adopted pursuant thereto. 30. Rule 64B5-17, Florida Administrative Code (2016), sets out the dental practice and principles by which licensees are to abide. 31. Rule 64B5-17001(3), Florida Administrative Code (2016), provides that within one month of a dentist's termination of practice, a notice shall be published in the newspaper of greatest general circulation in Department of Health v. Justin A. Martone, D.M.D. 5 Case Number 20th-21584

2006 the county where the dentist practiced which advises patients of the dentist's termination of practice. The notice shall advise patients that they may obtain copies of their dental records and specify the name, address and telephone number of the person from whom the copies of records may be obtained. The notice shall appear at least once a week for 4 consecutive weeks. 32. As set forth above, Respondent violated Section 466.028(1)(mm), Florida Statutes, through a violation of Rule 64E35-17.001, Florida Administrative Code, by failing to adhere to the notification requirements when he terminated his dental practice. [Signatures follow on next page] Department of Health v. Justin A. Martone, D.M.D, 6 Case Number 2016-21584

2007 WHEREFORE, the Petitioner respectfully requests that the Board of Dentistry enter an order imposing one or more of the following penalties: suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. SIGNED this day of / 2017. Celeste Philip, MD, MPH Surgeon General and Secretary of Health CLERK DATE FILED DEPARTMENT OF HEALTH DEPUTY CLERK Amber Greene JUL 1 4 2017 f/c R se-a'arrison A'ssistant General Counsel Fla. Bar No. 105920 Florida Department of Health Office of the General Counsel 4052 Bald Cypress Way, Bin #C65 Tallahassee, FL 32399-3265 Telephone: (850) 245-4640 ex. 8127 Facsimile: (850) 245-4681 Email: rose.garrison@flhealth.gov PCP: July 7, 2017 PCP Members: Dr. Thomas, Dr. Robinson, Dr. Miro Prepared: May 22, 2017 Department of Health V. Justin A. Martone, Case Number 2016-21584 7

2008 NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, 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 28-106.111(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 28-106.111(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 28-106.2015(5), Florida Administrative Code. Mediation under Section 120,573, Florida Statutes, is not available to resolve this Administrative Complaint. 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 456.072(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. Department of Health v. Justin A. Marton, D.M.D. 8 Case Number 2016-21584

1832 DEPARTMENT OF HEALTH, STATE OF FLORIDA BOARD OF DENTISTRY PETITIONER, v. CASE NO: 2017-00367 JUSTIN MARTONE, D.M.D., RESPONDENT. i ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through its undersigned counsel, files this Administrative Complaint before the Board of Dentistry against Respondent, Justin Martone, 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 first been issued license number DN 18184 on November 2, 2007. 3. Respondent's address on record with the Department is 514 A North State Road 7, Royal Palm Beach, Florida 33411.

1833 4. Respondent is currently located at 33 SE 8th Street, Apartment 405, Boca Raton, Florida 33432. 5. On or about November 8, 2012, Patient M.K. presented to Respondent at Respondent's former practice, Apple Tree Dental. 6. On that date, after conducting a limited oral evaluation, Respondent extracted Patient M.K.'s tooth number 32. 7. Respondent failed to document the results of the limited oral evaluation Respondent conducted on Patient M.K. 8. Respondent failed to document sufficient justification for the extraction of Patient M.K.'s tooth number 32. 9. Respondent failed to document justification for the use of anesthetic agents includes recording in the patient record the drugs used and the dosages of each drug used in administering anesthesia, including local anesthesia. 10. Section 466.028(1)(m), Florida Statutes (2012), provides that "[f]ailing to keep written dental records and medical history records justifying the course of treatment of the patients including, but not limited to, patient histories, examination results, test results, and X rays if taken" shall constitute grounds for disciplinary action by the Board of Dentistry. DOH v. Justin Martone, D.M.D. Case # 2017-00367

1834. 11. Rule 6465-17.002, Florida Administrative Code (2012), states that for the purpose of implementing the provisions of subsection 466.028(1)(m), Florida Statutes, a dentist shall maintain written records on each patient which written records shall contain, at a minimum, the following information about the patient: (a) Appropriate medical history; (b) Results of clinical examination and tests conducted, including the identification, or lack thereof, of any oral pathology or diseases; (c) Any radiographs used for the diagnosis or treatment of the patient; (d) Treatment plan proposed by the dentist; and (e) Treatment rendered to the patient. 12. Respondent violated Section 466.028(1)(m), Florida Statutes (2012), or Rule 6465-17.002, Florida Administrative Code (2012), in one or more of the following ways: A. By failing to document the results of the limited oral evaluation Respondent conducted on Patient M.K.; B. By failing to document sufficient justification for the extraction of Patient M.K.'s tooth number 32; or C. By failing to document justification for the use of anesthetic agents includes recording in the patient record the drugs DOH v. Justin Martone, D.M.D. Case # 2017-00367

1835 used and the dosages of each drug used in administering anesthesia, including local anesthesia 13. Based on the foregoing, Respondent has violated Section 466.028(1)(m), Florida Statutes (2012), or Rule 64B5-17.002, Florida Administrative Code (2012). WHEREFORE, Petitioner respectfully requests that the Board of Dentistry enter an order imposing one or more of the following penalties: restriction of practice, 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. SIGNED this c I day of 2017. Celeste Philip, MD, MPH State Surgeon General apd Secretary Octavio Simoes-Ponce, Esq. Assistant General Counsel Department of Health Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 (850) 245-4640 ext. 8230 FAX (850) 245-4684 Florida Bar # 0096511 Octavio.Simoes-Ponce@flhealth.gov DOH v. Justin Martone, D.M.D. Case # 2017-00367

1836 PCP: July 7, 2017 PCP Members: Joe Thomas, D.D.S., Chairperson, Claudio Miro, D.D.S., Panel Member, and William Robinson, D.D.S., Panel Member. FILED NT OF HEALTH DEPARTMETY DEPU CLERK CLERK NV atth-a-4, DATE. Itit 1 2. DOH v. Justin Marton, D.M.D. Case # 2017-00367

1837 NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, 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 28-106.111(2), Florida Administrative Code. Please send your request to: Department of Health Prosecution Services Unit Attention: Octavio Simoes-Ponce, Esq. 4052 Bald Cypress Way, Bin #C65 Tallahassee, Florida 32399-1701 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 28-106.111(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 28-106.2015(5), Florida Administrative Code. Please be advised that mediation under Section 120.573, Florida Statutes, is not available for administrative disputes involving this agency action. DOH v. Justin Martone, D.M.D. Case # 2017-00367

1838 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 456.072(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. DOH v. Justin Martone, D.M.D. Case # 2017-00367