Opinion ID: 2061760
Heading Depth: 1
Heading Rank: 7

Heading: scope of practice of dentistry

Text: The State's sixth and seventh assigned errors revolve around the district court's finding that Miller had not exceeded the scope of the practice of dentistry in using nutrition analysis to treat the patients in question. We review the judgment of the district court for errors appearing on the record and will not substitute our factual findings for those of the district court where competent evidence supports those findings. Norwest Corp. v. State, 253 Neb. 574, 571 N.W.2d 628 (1997); Vinci v. Nebraska Dept. of Corr. Serv., 253 Neb. 423, 571 N.W.2d 53 (1997); Spencer v. Omaha Pub. Sch. Dist., 252 Neb. 750, 566 N.W.2d 757 (1997). The question, therefore, is whether the decision conforms to the law, is supported by competent evidence, and is neither arbitrary, capricious, nor unreasonable. The Department of Health must prove by clear and convincing evidence its allegations that Miller both practiced outside the scope of dentistry and that he had invaded the practice of medicine. Section 71-183 provides the definition for the practice of dentistry. Specifically, § 71-183 provides that one is practicing dentistry if he or she: (1) Performs, or attempts or professes to perform, any dental operation or oral surgery or dental service of any kind [or] .... (6) [d]iagnoses, or professes to diagnose, prescribe for, or professes to prescribe for, treats, or professes to treat disease, pain, deformity, deficiency, injury, or physical condition of the human teeth or jaws, or adjacent structure. Based upon this definition, in its order filed April 5, 1996, the district court found: The evidence in the record (Plaintiff's dental records and testimony) demonstrates that Plaintiff customarily utilized blood and urine analysis in the diagnosis and treatment of specific dental problems related to the teeth, jaws or adjacent structures. It is abundantly clear that the Plaintiff's concern with nutritional deficiencies pertain and relate solely to the oral problems of his patients. The evidence in the record indicates that Miller's treatment of his patients was within the statutory definition of dentistry when that statute is read as a whole. Miller testified that the purposes of the blood and urine analyses in the four patients was to assist in prescribing an enzyme which, in turn, would aid digestion to alleviate problems that had manifested themselves in the oral cavity. Miller had never prescribed enzyme pills for non-oral conditions. The State urges that to read § 71-183 to allow for nutritional treatment of oral problems opens a Pandora's box, whereby dentists will be performing brain surgery in order to treat oral problems. The evidence was that Miller had completed 3,000 hours of postgraduate seminar training in orthodontics, periodontal surgery, nutrition, implantology, reconstruction, and cranial mandibular orthopedics, and was board-certified by the American Board of Oral Implantology. We emphasize, however, that the holding announced in this case is based upon a failure by the Department of Health to prove its allegations by clear and convincing evidence. No broad sweeping inferences may be made from the findings in this case. Instead, the facts of this case clearly show that Miller was using the blood and urine analyses to determine the nutrition of his patients in order to provide systemic treatment of specific oral problems. At numerous points during his testimony, Miller pointed out to the Department of Health that he did the blood and urine analyses on the four patients in question only to prescribe an enzyme to help digestion, which in turn would help problems which had manifested themselves in the oral cavity. Miller testified at one point that a multivitamin was not as effective as using the specific enzymes that the blood and urine tests could suggest. Miller further testified that he never prescribed any of the enzyme/vitamin pills for nonoral conditions such as bursitis. It is clear from the record that Miller was performing these tests only to treat deficiencies in the oral cavity, which clearly put Miller's treatment methods within the plain meaning of § 71-183. In addition to Miller's testimony, the testimony of the State's own expert, Tempero, supported the district court's reversal of the Department of Health's findings. At one point, Tempero testified that the use of the data compilations from the NESS company was outside the scope of practice of both dentistry and medicine. Tempero went on to testify that a practitioner would be within the scope of the practice of dentistry in using systemtic treatment of nutritional deficiencies to treat problems in the mouth. The only contrary evidence is Tempero's testimony that he thought a reasonable dentist would not rely on the information from the NESS company. Based upon this testimony, the district court found that the Department of Health had failed to establish by clear and convincing evidence that Miller had both practiced outside the scope of dentistry and had invaded the practice of medicine. Completely absent from the record is any positive testimony that Miller's actions invaded the scope of the practice of medicine. Instead, the State proceeded on the negative inference that if Miller practiced outside the scope of dentistry, then he must have been invading the practice of medicine. There is nothing untenable or erroneous about the district court's decision to reverse the Department of Health's findings. Based upon the evidence adduced at the hearing, the decision of the district court comports with a commonsense reading of § 71-183. We agree with the finding of the district court that the State failed to prove its case against Miller by clear and convincing evidence, and no error appears on the record from the district court.