WISCONSIN DEP ARTMENT OF
REGULATION & LICENSING
Wisconsin Department of Regulation & Licensing
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06/2?/!/37 OR:57 REGLILQTION FIND LICENSING $ GUTGLASS ERICKSO NC aai ~002/006
Stnteof W isconsin - I
In the Matterof DisciplinaryProceedings Against
FINAL DECISIONAND ORDER
for of are:
The partiesto this proceeding purposes s. 227.53,Stats.,
Brookfield W I 53005
Department Regulation Licensing
Madison W I 53708
Division of Enforcement
Madison W l 53708
The partiesto this proceeding to stipulation, Dentist
havingagreed the attached the y
ExaminingBoard makesthe following
I. ManijehKhorshidi, D.D.S.,was bornon June17, 1949,and is licensed pmcricedenu
the stateof W isconsinpursuant license
to on -i, ‘
number3729,first granted November
-.e_ ,’ 24,198
_- ..~ ~ .;.:--.,:
.‘ : 1-y-.;;‘ ..~.-’
2.X% June3, 1994.Dr~~Khb;shidi provideddentals~r&es to patientJ-c., a threeyearold
Tho child presented dilXcult patientmanagement a
situation,demonstratinghigh level of
anxietyandfear of dentalprocedures.
3. The patient’ father observed of the interaction from outsidethe trcatmcntarea. As
s the s
rcsuh of Dr. Khorshidi’ conducttowardthe patientfollowing trentment, patient’ fathr
complained Dr. KhorshIdihad frightened child by verbalandphyalcal contact.
06/25/97 OS:57 REGULRTION FlND LICENSfNG + GUTGLRSS ERICKSO NO. 481 P003f006
4. Dr. Khorshididoesnot agreethat sheengaged uny unprofessional her
conductwith PatientJ.C.,but shedoesagreethat her conductwas not perceived an
CONCLUSIONS LAW OF
1. The DentistryExaminingBoardhasjurisdictionin this matterpursuant S.447.07,Stats.
s of a
2. Dr. Khorshidi’ conductfollowing treatment PatientJ.C. constitutes violationof
It is ordered Dr. Khorshidishall complywith the following protocol whenever is treating
a pediatricpatientwho presents behaviormanagement challenge:
the of s in
1. Dr. Khnrshidishall request prcscnce the patient’ parentor guardian the
treatmentarcafor the durationof the procedure.
speakwith the child ta cat the
2. a. Dr. Khorshidiwill requestthat the parent/guardian
child. if successfbl, Khorshidiwill proceed the procedure.
b. If the parentor guardian’attemptto calm the child is unaucces~ful. Khorshi i wilt
T .: _.
discuss the of
with the parent/guardian administration nitrousoxide or Valium, Visteril, or 1
another tranquilizingor sedating medication..If the parenrlguardian the
agrees, sedative Iis
administered procedure continues.Dr. Khorshidiwill requestthut the parentor guardi
sign a consent of
form for the administration the sedative beforeadministering the
Khorshidimay administer nitrousoxide if shehasbeentrainedin its use,in compliance wi
DI? 11, W is. Admin. Code.
declines consent the admtnistration a
c. If the parentor guardian to to of
the sedative unsuccessful calmingthe child sufficientlyfor treatmentto proceed
otherintervention, Khorshidimay request parentor guardianto hold the child’ bans
legs to prevent child from injuring himselForherself. If the parentor
en may s
consents, assistant hold the child’ handsor legsinsteadof the
so. ...~ -_
r : I,j .:..-&. i I
possible treatthe child, despite
d. If it is ndt‘ to the
aid of a parentor guardian assistant holdingthe child’ s
term inatethe attemptat treatment, eitherrefer the
the patientfor anothertime end another attemptat treatment.Dr. Khorshidi may also
parent/guardian an option to admitthe child to
anesthetic. _.^ ;.___ _, ., - .--..x..
- ....:- . .
*ii ‘ so-
P 608 266 2264
06&S/97 ?0:le REGULATION AND LICENSING + GUTGLQSS ERICKSO No.
3. Whichevermethodis used, Dr. Khorshidi will beginthe procedureby addrcssin
simplesttask first incorporatingthe ‘ technique.
IT IS FURTHER ORDEREDthat Dr. Khorshidi will pay SlSOO.00 the Department of
pursuantt0 8.440.22. Stats.
Regulationand Licensinges the costs of this proceeding,
IT IS FURTHER ORDEREDthat the licensepreviouslyissuedto Manijeh Khorshidi,D.C
mny be summarily suspended any violation of this Order.
Dated this 9th day of Ju!y. 1997.
kl6/25/97 a8:58 REGULRTION RND LICENSING + GUTGLQSS ER[CKGO NO 81 P005/006
Stateof W isconsin
Beforethe Dentistry ExaminingBoard
In the Matterof DisciplinaryProceedings Against
CaseNo. LS 9605023 DEN
It is herebystipulatedbetween and
ManijehKhorshidi,D.D.S.,personally on her own
s and B.
behalf and ColleenFleming,Dr. Khorshidi’counsel, James Polewski,Attorney
Department Regulation Licensing, follows:
for the Division of Enforccmcnt, of and as
1. ‘ stipulationis emend in resolutionof the pendingmntterconcerning Dr.
Khorshidi’license. The Stipulation the proposed Final DecisionandO rdershall t
directly to tho DontistryExaminingBoardfor its consideration adoption
2. ht resolutionof theseproceedings, Khonhidi consents the entry of the attach1
Final Decisionand O rder.
3. Dr. Khorshidi is nwareof andunderstands of her righlr, including:
l - on
the right to a hearing the allegations her,
against at which the statewou
havethe burdenof provingthe allegations a preponderance the of
the right to confrontandcross-examine witnesses againsther,
l .’ the right to call witnesses his own behalf andto compcitheir attendant,
l .~ the right to testify herself,
l _ to
the right to file objections any proposed and
decision to presentbriefs o
orat arguments the offtcials who areto render final decision,
_ v *I the right to peiitionfor rehearing,
* c the right to be represented every stageof the proceeding, includingthe
makingof anystipulation, an attorneyof her choosing, her own
. all other rightsaffordedto her under the UnitedStates Constitution,the
W isconsinConstitution, W isconsinStatutes the W isconsin
Administrative Code. .y-,- _
4. Dr. Khorshidiis awareandunderstands by signingthis stipulation voluntari
and knowingly waivesthe rightssetforth in paragraph above, doesvoluntarily an
knowingly waive thoserights. : i
LdD/Z3/~I ldt(i53 REGULATION RND LICENSING + GUTGLQSS ERICKSO NO 31 P006/006
5. If the terms of this stipulation not acceptable the Board,thepartiesshallnot I
boundby the contents this stipulation,and the mnttershullbe returned the Divisil
of Enforccmcntfor furtherproceedings. the cvcnt that this stipulationis not accepts
by the Board,the pnrticsagree to contendthat the Boardhasbeenprcjudiccd or
biasedin any mannerby the consideration this attempted resolution.
6. The particsto this stipulationagreethat the attorneyfor the Division of Enforcemel
andthe memberof the DentistryExaminingBoardassigned an advisorin this
investigationmay appear in
beforethe Board for the purposeof speaking favor of this
agreement answering that of
questions the members the Boardmay havein
with their deliberations the stipulation.
t 3s &F?
Division of Enforcement
_ -_ .Y.__~ .., .
STATE OF WISCONSIN
DEPARTMENT OF REGULATION AND LICENSING
BEFORE THE DENTISTRY EXAMINING BOARD
In the Matter of the Disciplinary ProceedingsAgainst
Manijeh Khorshidi, D.D.S., AFFIDAVIT OF MAILING
STATE OF WISCONSIN )
COUNTY OF DANE
1, Kate Rotenberg, having been duly sworn on oath, state the following to be true and
correct basedon my personal knowledge:
1: I am employed by the Wisconsin Department of Regulation and Licensing.
2. On July 10, 1997, I served the Final Decision and Order dated July 9, 1997,
LS9605023DEN, upon the RespondentManijeh Khorshidi’ attorney by enclosing a true and
accuratecopy of the above-describeddocument in an envelope properly stamped and addressed
to the above-namedRespondent’ attorney and placing the envelope in the State of Wisconsin
mail system to be mailed by the United StatesPost Office by certified mail. The certified mail
receipt number on the envelope is P 221 157 325.
Colleen Fleming, Attorney
735 N. Water Street, Suite 1400
Milwaukee WI 53202-4267
Department of Regaation and Licensing
Office of Legal Counsel
Notary Pub!& &ate 6f Wisconsin
My commission is permanent.
NOTICE OF APPEAL INFORMATION
Notice Of Rights For Rehearing Or Judiciaf Review, The Times Allowed For
Each, And The Identification Of The Party To Be Named As Respondent.
Serve Petition for Rehearing or Judicial Review on:
STATE OF-WISCONSIN DENTISTRY EXAMINING BOARD
1400 East Washington Avenue -A
P.O. Box 8935 i ?
won, w53,0** : ..: