{ "id": 2986024, "name": "PAUL E. WATKINS, D.D.S., Petitioner v. NORTH CAROLINA STATE BOARD OF DENTAL EXAMINERS, Respondent", "name_abbreviation": "Watkins v. North Carolina State Board of Dental Examiners", "decision_date": "2004-04-02", "docket_number": "No. 301A03", "first_page": "190", "last_page": "209", "citations": [ { "type": "official", "cite": "358 N.C. 190" } ], "court": { "name_abbreviation": "N.C.", "id": 9292, "name": "Supreme Court of North Carolina" }, "jurisdiction": { "id": 5, "name_long": "North Carolina", "name": "N.C." }, "cites_to": [ { "cite": "579 S.E.2d 510", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2003, "opinion_index": -1 }, { "cite": "157 N.C. App. 367", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 9186873 ], "year": 2003, "opinion_index": -1, "case_paths": [ "/nc-app/157/0367-01" ] }, { "cite": "188 S.E.2d 281", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1972, "pin_cites": [ { "page": "283" } ], "opinion_index": 0 }, { "cite": "281 N.C. 300", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8574896 ], "year": 1972, "pin_cites": [ { "page": "303" } ], "opinion_index": 0, "case_paths": [ "/nc/281/0300-01" ] }, { "cite": "210 S.E.2d 193", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1974, "pin_cites": [ { "page": "195" } ], "opinion_index": 0 }, { "cite": "286 N.C. 226", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8565019 ], "year": 1974, "pin_cites": [ { "page": "229" } ], "opinion_index": 0, "case_paths": [ "/nc/286/0226-01" ] }, { "cite": "76 S.E. 203", "category": "reporters:state_regional", "reporter": "S.E.", "year": 1912, "pin_cites": [ { "page": "208" } ], "opinion_index": 0 }, { "cite": "160 N.C. 176", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 11270937 ], "year": 1912, "pin_cites": [ { "page": "188" } ], "opinion_index": 0, "case_paths": [ "/nc/160/0176-01" ] }, { "cite": "118 S.E.2d 303", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1961, "pin_cites": [ { "page": "310" }, { "page": "310" } ], "opinion_index": 0 }, { "cite": "254 N.C. 47", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8624259 ], "weight": 2, "year": 1961, "pin_cites": [ { "page": "57" }, { "page": "57" } ], "opinion_index": 0, "case_paths": [ "/nc/254/0047-01" ] }, { "cite": "281 S.E. 2d 24", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1981, "pin_cites": [ { "page": "29" } ], "opinion_index": 0 }, { "cite": "303 N.C. 573", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8574954 ], "year": 1981, "pin_cites": [ { "page": "580-81" } ], "opinion_index": 0, "case_paths": [ "/nc/303/0573-01" ] }, { "cite": "269 S.E.2d 547", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 5, "year": 1980, "pin_cites": [ { "page": "565" }, { "page": "565" }, { "page": "561" }, { "page": "561" } ], "opinion_index": 0 }, { "cite": "300 N.C. 381", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8562647 ], "weight": 4, "year": 1980, "pin_cites": [ { "page": "406" }, { "page": "406" }, { "page": "399" }, { "page": "399" } ], "opinion_index": 0, "case_paths": [ "/nc/300/0381-01" ] }, { "cite": "231 S.E.2d 882", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1977, "pin_cites": [ { "page": "888" } ], "opinion_index": 0 }, { "cite": "292 N.C. 70", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8567415 ], "year": 1977, "pin_cites": [ { "page": "80" } ], "opinion_index": 0, "case_paths": [ "/nc/292/0070-01" ] }, { "cite": "259 S.E.2d 298", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1979, "opinion_index": 0 }, { "cite": "298 N.C. 294", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8570336, 8570284, 8570444, 8570383, 8570419 ], "year": 1979, "opinion_index": 0, "case_paths": [ "/nc/298/0294-02", "/nc/298/0294-01", "/nc/298/0294-05", "/nc/298/0294-03", "/nc/298/0294-04" ] }, { "cite": "255 S.E.2d 328", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1979, "pin_cites": [ { "page": "330" } ], "opinion_index": 0 }, { "cite": "41 N.C. App. 567", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8550641 ], "year": 1979, "pin_cites": [ { "page": "569" } ], "opinion_index": 0, "case_paths": [ "/nc-app/41/0567-01" ] }, { "cite": "233 S.E.2d 538", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1977, "pin_cites": [ { "page": "541" }, { "page": "541" } ], "opinion_index": 0 }, { "cite": "292 N.C. 406", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8569880 ], "weight": 2, "year": 1977, "pin_cites": [ { "page": "410" }, { "page": "410" } ], "opinion_index": 0, "case_paths": [ "/nc/292/0406-01" ] }, { "cite": "498 S.E.2d 616", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1998, "pin_cites": [ { "page": "620", "parenthetical": "citing Thompson v. Wake Cty Bd. of Educ., 292 N.C. 406, 410, 233 S.E.2d 538, 541 (1977)" } ], "opinion_index": 0 }, { "cite": "348 N.C. 230", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 1659888 ], "weight": 2, "year": 1998, "pin_cites": [ { "page": "237", "parenthetical": "citing Thompson v. Wake Cty Bd. of Educ., 292 N.C. 406, 410, 233 S.E.2d 538, 541 (1977)" }, { "page": "237" } ], "opinion_index": 0, "case_paths": [ "/nc/348/0230-01" ] }, { "cite": "531 S.E.2d 795", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2000, "pin_cites": [ { "page": "797" } ], "opinion_index": 0 }, { "cite": "352 N.C. 349", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 685086 ], "year": 2000, "pin_cites": [ { "page": "352" } ], "opinion_index": 0, "case_paths": [ "/nc/352/0349-01" ] }, { "cite": "565 S.E.2d 9", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2002, "pin_cites": [ { "page": "17" } ], "opinion_index": 0 }, { "cite": "356 N.C. 1", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 1511222 ], "year": 2002, "pin_cites": [ { "page": "13" } ], "opinion_index": 0, "case_paths": [ "/nc/356/0001-01" ] }, { "cite": "577 S.E.2d 622", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2003, "opinion_index": 0 }, { "cite": "357 N.C. 42", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 491675 ], "year": 2003, "opinion_index": 0, "case_paths": [ "/nc/357/0042-01" ] }, { "cite": "566 S.E.2d 486", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2002, "pin_cites": [ { "page": "492-93", "parenthetical": "Greene, J., dissenting" } ], "opinion_index": 0 }, { "cite": "151 N.C. App. 367", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 9080377 ], "year": 2002, "pin_cites": [ { "page": "378-79", "parenthetical": "Greene, J., dissenting" } ], "opinion_index": 0, "case_paths": [ "/nc-app/151/0367-01" ] }, { "cite": "418 N.E.2d 1236", "category": "reporters:state_regional", "reporter": "N.E.2d", "year": 1981, "pin_cites": [ { "page": "1244" } ], "opinion_index": 0 }, { "cite": "383 Mass. 299", "category": "reporters:state", "reporter": "Mass.", "case_ids": [ 813449 ], "year": 1981, "pin_cites": [ { "page": "310" } ], "opinion_index": 0, "case_paths": [ "/mass/383/0299-01" ] }, { "cite": "399 N.E.2d 1251", "category": "reporters:state_regional", "reporter": "N.E.2d", "weight": 2, "year": 1980, "pin_cites": [ { "page": "1255" } ], "opinion_index": 0 }, { "cite": "61 Ohio St. 2d 168", "category": "reporters:state", "reporter": "Ohio St. 2d", "case_ids": [ 1803308 ], "year": 1980, "pin_cites": [ { "page": "174" } ], "opinion_index": 0, "case_paths": [ "/ohio-st-2d/61/0168-01" ] }, { "cite": "67 S.E.2d 57", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1951, "pin_cites": [ { "page": "61" } ], "opinion_index": 0 }, { "cite": "234 N.C. 222", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8621029 ], "year": 1951, "pin_cites": [ { "page": "226-27" } ], "opinion_index": 0, "case_paths": [ "/nc/234/0222-01" ] }, { "cite": "97 S.E.2d 232", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1957, "pin_cites": [ { "page": "236" } ], "opinion_index": 0 }, { "cite": "245 N.C. 612", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8616175, 8616631 ], "year": 1957, "pin_cites": [ { "page": "616-17" } ], "opinion_index": 0, "case_paths": [ "/nc/245/0612-01", "/nc/245/0612-02" ] }, { "cite": "309 S.E.2d 219", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 3, "year": 1983, "pin_cites": [ { "page": "227" } ], "opinion_index": 0 }, { "cite": "309 N.C. 710", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 4761485 ], "weight": 2, "year": 1983, "pin_cites": [ { "page": "724" } ], "opinion_index": 0, "case_paths": [ "/nc/309/0710-01" ] }, { "cite": "488 S.E.2d 245", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 17, "year": 1997, "pin_cites": [ { "page": "245-46" }, { "page": "248" }, { "page": "248" }, { "page": "248" }, { "page": "248", "parenthetical": "emphasis added" }, { "page": "248" }, { "page": "248" }, { "page": "249" }, { "page": "249" } ], "opinion_index": 0 }, { "cite": "346 N.C. 775", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 139326 ], "weight": 6, "year": 1997, "pin_cites": [ { "page": "780" }, { "page": "780-81" }, { "page": "780" }, { "page": "781" } ], "opinion_index": 0, "case_paths": [ "/nc/346/0775-01" ] }, { "cite": "579 S.E.2d 510", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 3, "year": 2003, "pin_cites": [ { "page": "515" }, { "page": "515", "parenthetical": "2003" }, { "page": "515" } ], "opinion_index": 0 }, { "cite": "157 N.C. App. 367", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 9186873 ], "weight": 2, "year": 2003, "pin_cites": [ { "page": "374" }, { "page": "375" } ], "opinion_index": 0, "case_paths": [ "/nc-app/157/0367-01" ] } ], "analysis": { "cardinality": 1464, "char_count": 48915, "ocr_confidence": 0.756, "pagerank": { "raw": 5.731505671441833e-07, "percentile": 0.95014979637809 }, "sha256": "20e003eb61d479a3cd0c5887a83190b2d44096b8f745d8d40aa4ea3f29f0869d", "simhash": "1:1144c4f2141364a2", "word_count": 7667 }, "last_updated": "2023-07-14T22:12:52.416221+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [], "parties": [ "PAUL E. WATKINS, D.D.S., Petitioner v. NORTH CAROLINA STATE BOARD OF DENTAL EXAMINERS, Respondent" ], "opinions": [ { "text": "MARTIN, Justice.\nPetitioner, Paul E. Watkins, is a dentist licensed to practice dentistry in North Carolina who limits his practice in this state to the specialty area of orthodontics. Based on formal complaints initiated by three of petitioner\u2019s patients \u2014 John Casto, Conrad Naico, and Sabrina Wolfe \u2014 the North Carolina Board of Dental Examiners (Dental Board or the Board) held an administrative hearing to determine if petitioner had violated applicable provisions of the Dental Practice Act, N.C.G.S. \u00a7 90-22 to 90-48.3 (2003). The evidence presented at the hearing included documentary evidence as well as lay and expert testimony. On 18 July 2001, the Board issued its final agency decision, concluding that petitioner\u2019s failure to comply with the applicable standards of care in his treatment of all three patients constituted negligence in the practice of dentistry within the meaning of N.C.G.S. \u00a7 90-41(a)(12) (2003). Accordingly, the Board ordered that petitioner\u2019s license be suspended for a period of six months, with conditional restoration subject to petitioner\u2019s adherence to probationary terms.\nPetitioner sought judicial review of the Board\u2019s order in Wake County Superior Court. By judgment signed 5 April 2002, the trial court reversed and remanded to the Board for reinstatement of petitioner\u2019s license. The trial court concluded that the Board\u2019s determination that petitioner was negligent in the practice of dentistry was unsupported by substantial, material, and competent evidence in view of the entire record and, therefore, that the suspension of petitioner\u2019s license was arbitrary and capricious. A divided panel of the Court of Appeals affirmed, and respondent appealed to this Court as a matter of right. We reverse.\nI.\nThe first issue presented is whether the Board was authorized, under Leahy v. North Carolina Bd. of Nursing, 346 N.C. 775, 488 S.E.2d 245 (1997), to determine the appropriate standard of care for petitioner\u2019s treatment of patient John Casto (Casto) without expert testimony from an orthodontist.\nAt the outset, we note that this issue does not encompass the Board\u2019s consideration of petitioner\u2019s treatment of Sabrina Wolfe (Wolfe) and Conrad Naico (Naico). With respect to Wolfe and Naico, Board experts testified as to the requisite standards of care in addition to offering their expert opinions that petitioner had breached those standards. With regard to Casto, on the other hand, the Board\u2019s expert witness, Dr. Christopher Trentini, testified that Casto\u2019s progress \u201cwas behind schedule, clearly\u201d given the nature of Casto\u2019s orthodontic problems and the length of time he had been in treatment. Dr. Trentini did not testify that the standard of care for orthodontists practicing in North Carolina required a more timely resolution of Casto\u2019s orthodontic problems. Nevertheless, after reviewing the dental records and the expert and lay testimony presented, the Board found that the standard of care for dentists licensed to practice in North Carolina \u201crequired an orthodontist to establish and follow a treatment plan which would address the patient\u2019s orthodontic needs in a timely manner.\u201d The Board also found that petitioner \u201cviolated the standard of care ... by failing to establish and follow a treatment plan that would address the patient\u2019s orthodontic needs in a timely manner.\u201d The Board concluded that petitioner\u2019s failure to comply with the applicable standard of care in his treatment of Casto was a \u201cdereliction from professional duty constituting negligence in the practice of dentistry within the meaning of N.C.G.S. \u00a7 90-41(a)(12).\u201d\nPetitioner argues that given the absence of expert testimony as to the appropriate standard of care and breach thereof, the Board lacked substantial evidence to support its conclusion that petitioner\u2019s treatment of Casto constituted negligence in the practice of dentistry. This argument, however, is foreclosed by our holding in Leahy, which we now reaffirm.\nLeahy involved a disciplinary action by the North Carolina Board of Nursing (Nursing Board) against a registered nurse (the petitioner or Leahy) concerning her treatment of two patients. Leahy, 346 N.C. 775, 488 S.E.2d 245. At that hearing before the Nursing Board, four nurses presented eyewitness testimony as to the factual details of the conduct at issue. Id. at 776-77, 488 S.E.2d at 245-46. They did not, however, testify as to the requisite standard of care for registered nurses. Id. The Nursing Board found facts consistent with the eyewitnesses\u2019 testimony and concluded that Leahy\u2019s treatment of the two patients breached the requisite standard of care in violation of the Nursing Practice Act. Id. at 778, 448 S.E.2d at 247. Relying on our holding in Dailey v. North Carolina State Bd. of Dental Exam\u2019rs, 309 N.C. 710, 309 S.E.2d 219 (1983), the Court of Appeals reversed, holding that the Board\u2019s suspension of the petitioner\u2019s license was improper because of the absence of expert testimony defining the standard of care for registered nurses in the practice of their profession. Leahy, 346 N.C. at 780, 488 S.E.2d at 248.\nWe reversed the Court of Appeals, rejecting the argument that expert testimony was required to establish the applicable standard of care. Leahy, 346 N.C. at 780-81, 488 S.E.2d at 248. In reaching this decision, we turned to North Carolina\u2019s Administrative Procedure Act (APA), which expressly provides that \u201c[a]n agency may use its experience, technical competence, and specialized knowledge in the evaluation of evidence presented to it.\u201d Id. (quoting N.C.G.S. \u00a7 150B-41(d) (1995)). We concluded that the specialized knowledge of the Nursing Board \u201cincludes knowledge of the standard of care for nurses,\u201d and thus that the Nursing Board was entitled to use this knowledge in evaluating the evidence before it. Id. at 781, 488 S.E.2d at 248. In support of this conclusion, we looked to the composition and statutorily prescribed functions of the Nursing Board, noting that it (1) consisted of nine registered nurses, four licenced practical nurses, one retired doctor, and one layperson; (2) was authorized by statute to develop rules and regulations to govern medical acts by registered nurses; (3) was empowered to administer, interpret, and enforce the Nursing Practice Act; and (4) was required by statute to establish the qualifications and criteria for licensure of nurses. Id. Reasoning that \u201c[t]o meet these requirements, the [Nursing] Board must know the standard of care for registered nurses in this state,\u201d we held that the Court of Appeals had erred in requiring expert testimony to establish that standard. Id.\nLeahy illustrates the deference that courts accord to administrative bodies in the exercise of their factfinding functions. See, e.g., In re Berman, 245 N.C. 612, 616-17, 97 S.E.2d 232, 236 (1957). We acknowledge that, in a medical malpractice action, the standard of care is normally established by the testimony of a qualified expert. Jackson v. Mountain Sanitarium & Asheville Agrie. Sch., 234 N.C. 222, 226-27, 67 S.E.2d 57, 61 (1951). This general rule is based on the recognition that in the majority of cases the standard of care for health providers concerns technical matters of \u201chighly specialized knowledge,\u201d and a lay factfinder is \u201cdependent on expert testimony\u201d to fairly determine that standard. Id. This rationale is not necessarily controlling within the context of disciplinary proceedings conducted by professional licensing boards where, as here, the factfinding body is composed entirely or predominantly of experts charged with the regulation of the profession. See Arlen v. State Med. Bd., 61 Ohio St. 2d 168, 174, 399 N.E.2d 1251, 1255 (1980). Thus, we decline to impose a per se rule that expert testimony is required to establish the standard of care in disciplinary hearings conducted by professional licensing boards.\nPetitioner contends that Leahy is distinguishable in light of the relative compositions of the Dental and Nursing Boards. In Leahy, petitioner argues, the Nursing Board was competent to establish the standard of care for registered nurses without the benefit of expert testimony because, by statute, at least eight of its fifteen members must be registered nurses. N.C.G.S. \u00a7 9d-171.21(a) (2003). In the present case, by contrast, the Dental Practice Act does not mandate that any orthodontists serve on the Board, see N.C.G.S. \u00a7 90-22(b) (2003), and at the time petitioner\u2019s case came on for hearing, none did. Thus, petitioner argues, the Board lacked the requisite expertise, technical training, and specialized knowledge to determine the standard of care for orthodontists. For the following reasons, we reject this argument and hold that Leahy controls our resolution of the present case.\nThe Dental Practice Act vests the Board with broad authority to regulate the practice of dentistry, including the powers to grant or revoke a license and to enact rules and regulations governing the profession. N.C.G.S. \u00a7\u00a7 90-41(a), 90-48 (2003). Moreover, the General Assembly has clearly defined the \u201cpractice of dentistry\u201d to encompass the practice of orthodontics. Compare N.C.G.S. \u00a7 90-29(b)(5) (2003) (defining the \u201cpractice of dentistry\u201d to include \u201c[c]orrect[ing] the malposition or malformation of human teeth\u201d) with Oxford English Dictionary, Supplement and Bibliography (1961) (defining \u201corthodontia\u201d as \u201c[t]he correcting of irregular and faulty positions of the teeth\u201d). There are no distinct licensure requirements for orthodontists in this state, and orthodontists \u2014 like all licensed dentists \u2014 are subject to the regulatory and disciplinary authority of the Dental Board as it is statutorily composed. See N.C.G.S. \u00a7\u00a7 90-29(a), 90-41(a). By statute, the Board is composed of six licensed dentists, one dental hygienist, and one layperson. See N.C.G.S. \u00a7 90-22(a). There is no statutory requirement of orthodontic representation on the Board. Id. Thus, in the statutory scheme adopted by the legislature, orthodontists are regulated as dentists, by dentists. Although they practice in a specialty area within their profession, orthodontists are held accountable to the same disciplinary authority under the same statutory provisions as their peers who practice general dentistry.\nMoreover, the Dental Practice Act specifically precludes the dental hygienist and lay members of the Board from participating in any matter involving the issuance, renewal, or revocation of a license to practice dentistry. N.C.G.S. \u00a7 90-22(b). This express exclusion of the two members who are not licensed dentists strongly suggests that the General Assembly gave due consideration to the competence of the Board as composed to adjudicate disciplinary matters. Under these circumstances, the fact that the General Assembly did not see fit to make any special provisions for disciplinary actions involving orthodontists suggests that it deemed the standards of care governing the practice of orthodontics to be within the ken of licensed dentists. In deference to this legislative judgment, we will not engraft a rule requiring expert testimony on the regulatory scheme devised by the General Assembly.\nPetitioner asserts that liberal application of Leahy effectively vests professional licensing boards with \u201cunfettered discretion\u201d to revoke or deny a license, thereby rendering a licensee\u2019s statutory right to judicial review meaningless. We disagree. Far from undermining a licensee\u2019s right to have the merits of his or her case determined on the basis of facts in evidence, Leahy reaffirms that right as it was previously articulated in Dailey.\nThe APA provides that in all contested cases, an agency must base its findings of fact exclusively on evidence presented and facts officially noticed, all of which must be made a part of the official record for purposes of judicial review. N.C.G.S. \u00a7\u00a7 150B-41(b), 150B-42(a)~(b), 150B-47 (2003). In Dailey, we emphasized that the preservation of a record for judicial review was a \u201ccornerstone of the Administrative Procedure Act\u201d in that it enables a reviewing court to determine whether an agency, including a professional licensing board, has engaged in a \u201creasoned evaluation and analysis of [the] evidence presented.\u201d 309 N.C. at 724, 309 S.E.2d at 227. We further stated that while a licensing board \u201c \u2018may put its expertise to use in evaluating the complexities of technical evidence,\u2019 \u201d it \u201c \u2018may not use its expertise as a substitute for evidence in the record.\u2019 \u201d Id. (quoting Arthurs v. Board of Registration in Med., 383 Mass. 299, 310, 418 N.E.2d 1236, 1244 (1981)).\nLeahy in no way derogates from this aspect of our reasoning in Dailey. As we clarified in Leahy, \u201c[t]he concern in Dailey was that the board would use its own expertise to decide the case without any evidence to support it.\" Leahy, 346 N.C. at 780, 488 S.E.2d at 248 (emphasis added). In Leahy, however, \u201cthere [was] evidence in the record which the Board could use its expertise to interpret,\u201d including eyewitness testimony describing the petitioner\u2019s conduct. Id. We upheld the revocation, of the petitioner\u2019s license in Leahy because we determined that (1) the Nursing Board was entitled to use its expertise in interpreting the evidence presented and (2) that expertise included knowledge of the standard of care for nurses. Id. at 780-81, 488 S.E.2d at 248. The petitioner\u2019s right to meaningful judicial review was preserved because \u201c[f]rom the record, we [were] able to determine the validity of the Board\u2019s action.\u201d Id. at 780, 488 S.E.2d at 248.\nLeahy overruled Dailey to the extent that Dailey implied the standard of care in licensing board cases must be established by expert testimony. Leahy, 346-N.C. at 781, 488 S.E.2d at 249. Under Leahy, where knowledge of the requisite standard of care must be within the board\u2019s specialized knowledge and expertise, the board may apply the appropriate standard even \u201cif no evidence of it is introduced.\u201d Id. Leahy does not, however, empower a licensing board to base its findings or conclusions on facts outside the record. See Sibley v. North Carolina Bd. of Therapy Exam\u2019rs, 151 N.C. App. 367, 378-79, 566 S.E.2d 486, 492-93 (2002) (Greene, J., dissenting) (citing Leahy for the proposition that board findings \u201cmust be based on the evidence and cannot merely rest on the Board\u2019s expertise with respect to the practice of physical therapy\u201d), rev\u2019d per curiam for the reasons stated in the dissent, 357 N.C. 42, 577 S.E.2d 622 (2003). Nor does Leahy excuse an agency from its statutory obligation to reach a reasoned decision based on \u201csubstantial evidence ... in view of the entire record.\u201d N.C.G.S. \u00a7 150B-51(b)(5) (2003). Accordingly, Leahy does not undermine a licensee\u2019s right to seek meaningful judicial review of the Board\u2019s decision.\nII.\nThe next issue presented is whether there was substantial evidence in the record to support the Board\u2019s findings of fact and conclusions of law with respect to petitioner\u2019s treatment of Casto and Naico.\nJudicial review of the final decision of an administrative agency in a contested case is governed by section 150B-51(b) of the APA. N.C.G.S. \u00a7 150B-51(b). When the issue for review is whether an agency\u2019s decision was supported by substantial evidence in view of the entire record, N.C.G.S. \u00a7 150B-51 (b)(5), a reviewing court must apply the \u201cwhole record\u201d test. Mann Media, Inc. v. Randolph Cty Planning Bd., 356 N.C. 1, 13, 565 S.E.2d 9, 17 (2002); In re Gordon, 352 N.C. 349, 352, 531 S.E.2d 795, 797 (2000). A court applying the whole record test may not substitute its judgment for the agency\u2019s as between two conflicting views, even though it could reasonably have reached a different result had it reviewed the matter de novo. Elliot v. North Carolina Psychology Bd., 348 N.C. 230, 237, 498 S.E.2d 616, 620 (1998) (citing Thompson v. Wake Cty Bd. of Educ., 292 N.C. 406, 410, 233 S.E.2d 538, 541 (1977)); Boehm v. North Carolina Bd. of Podiatry Exam\u2019rs, 41 N.C. App. 567, 569, 255 S.E.2d 328, 330 (1979), cert. denied, 298 N.C. 294, 259 S.E.2d 298 (1979). Rather, a court must examine all the record evidence \u2014 that which detracts from the agency\u2019s findings and conclusions as well as that which tends to support them \u2014 to determine whether there is substantial evidence to justify the agency\u2019s decision. Elliot, 348 N.C. at 237, 498 S.E.2d at 620 (citing Thompson, 292 N.C. at 410, 233 S.E.2d at 541). \u201cSubstantial evidence\u201d is defined as \u201crelevant evidence a reasonable mind might accept as adequate to support a conclusion.\u201d N.C.G.S. \u00a7 150B-2(8b) (2003); State ex rel. Comm\u2019r of Ins. v. North Carolina Fire Ins. Rating Bureau, 292 N.C. 70, 80, 231 S.E.2d 882, 888 (1977).\nWe first examine the sufficiency of the evidence to support the Board\u2019s findings and conclusions regarding Casto. Casto, a minor child, first presented to petitioner\u2019s office on 22 April 1996. Petitioner diagnosed Casto as having a Class I malocclusion, \u201cseverely crowded locked out maxillary bicuspids, and severely crowded mandibular anterior incisors.\u201d Dental molds revealed that Casto presented to petitioner with a \u201cmidline deviation\u201d of two millimeters. Petitioner devised a treatment plan of \u201ctherapeutic nonextraction,\u201d which called for the initial use of orthodontic appliances with possible future extractions of the upper and lower right first bicuspids.\nPetitioner did not initiate Casto\u2019s treatment until four months later, on 26 August 1996. Although petitioner\u2019s office informed Casto\u2019s mother (Ms. Casto) that it was awaiting notification of Casto\u2019s Medicaid approval during this period, petitioner admits that his office never actually submitted the case to Medicaid.\nOn 22 October 1997, petitioner referred Casto for the extraction of his upper and lower right first bicuspids and continued treatment with orthodontic appliances. In the spring of 1998, after nearly two years of treatment, Ms. Casto became dissatisfied with her son\u2019s progress under petitioner\u2019s care and demanded an estimate of how much additional time Casto\u2019s treatment would require. Petitioner estimated that Casto would require an additional year of treatment. After petitioner\u2019s office cancelled three consecutive appointments for various reasons in August 1998, Ms. Casto consulted her general dentist for a referral to a different orthodontist.\nThat orthodontist, Dr. Trentini, testified at petitioner\u2019s hearing as an expert witness for the Board. Dr. Trentini testified that based on his initial consultation and a review of Casto\u2019s records, Casto would require an additional eighteen months of treatment. He also testified that Casto\u2019s treatment was \u201cbehind schedule, clearly\u201d at the time Casto first presented to his office and that petitioner\u2019s decision to pursue unilateral extractions on the right side only of Casto\u2019s mouth had worsened Casto\u2019s preexisting midline deviation in violation of the applicable standard of care. In a letter addressed to the Board and entered into evidence at petitioner\u2019s hearing, Dr. Trentini further stated that in his opinion \u201c[Casto\u2019s] treatment prior to transferring was significantly delayed relative to his time in treatment.\u201d\nIn light of these facts, the Board found that petitioner had breached the requisite standard of care for orthodontists by failing to establish and follow a treatment plan which would address Casto\u2019s orthodontic needs \u201cin a timely manner.\u201d The Board concluded that this breach of the requisite standard of care constituted negligence in the practice of dentistry within the meaning of N.C.G.S. \u00a7 90-41(a)(12).\nHaving reviewed the whole record, we cannot say that the Board\u2019s finding that petitioner failed to treat Casto \u201cin a timely manner\u201d was unsupported by substantial evidence. Although the Board did not receive expert testimony specifically stating that the standard of care for dentists practicing orthodontics requires \u201ctimeliness\u201d in the treatment of patients, the Board was entitled under Leahy to apply its expert knowledge of this standard of care to the facts before it, even if \u201cno evidence of [the standard of care was] introduced.\u201d Leahy, 346 N.C. at 781, 488 S.E.2d at 249. In the present case, the Board could reasonably have concluded that petitioner\u2019s delay in initiating treatment, his decision to pursue an initial policy of \u201ctherapeutic nonextraction,\u201d and his eventual decision to extract unilaterally on one side of the mouth all contributed to an unreasonable delay in Casto\u2019s progress as an orthodontic patient.\nIn his brief, petitioner suggests that any delay in Casto\u2019s treatment resulted from either patient noncompliance or appliance breakage that cannot be attributed to negligence on petitioner\u2019s part. Petitioner cites no record evidence in support of this contention. Nonetheless, the record does reflect that petitioner regularly instructed his patients not to chew on hard foods or objects to avoid breaking brackets. Moreover, Casto admits that on at least one occasion he broke a bracket by chewing on a pen in contravention of petitioner\u2019s instructions.\nWe agree that this evidence tends to detract from the Board\u2019s findings that any delay in Casto\u2019s treatment was attributable to petitioner\u2019s negligence, and we encompass this evidence within our review of the whole record. We note, however, that the Board was also presented with evidence that tends to undermine petitioner\u2019s \u201cbroken bracket\u201d defense. First, Casto and his mother both testified that Casto\u2019s brackets often came loose immediately or shortly after placement, suggesting that improper placement, not patient noncompliance, was the cause of the problem. Second, Dr. Trentini testified that it was his practice to repair broken brackets at a patient\u2019s regularly scheduled appointment, in addition to completing any previously scheduled work. Petitioner, on the other hand, repaired broken brackets at a patient\u2019s regularly scheduled appointment but typically rescheduled for any previously scheduled work, thus necessarily extending the course of treatment. Finally, Dr. Trentini testified that Casto had only one \u201cloose\u201d bracket in nineteen months of treatment with him. By comparison, petitioner\u2019s treatment records for Casto reflect at least five broken brackets over the course of twenty-one months.\nIn cases appealed from an administrative tribunal, it is the responsibility of the administrative body, not a reviewing court, \u201cto determine the weight and sufficiency of the evidence and the credibility of the witnesses, to draw inferences from the facts, and to appraise conflicting and circumstantial evidence.\u201d State ex rel. Comm\u2019r of Ins. v. North Carolina Rate Bureau, 300 N.C. 381, 406, 269 S.E.2d 547, 565 (1980). Thus, it fell within the province of the Board to determine whether the delay in Casto\u2019s treatment was attributable to a flawed treatment plan, as Dr. Trentini testified, or to patient noncompliance, as petitioner alleges. To the extent the evidence diverges, we defer to the Dental Board\u2019s resolution of any conflicts. On the basis of the record before us, we cannot conclude that the Board lacked \u201crelevant evidence a reasonable mind might accept as adequate,\u201d N.C.G.S. \u00a7 150B-2(8b), to support its conclusion that petitioner\u2019s treatment of Casto was untimely and that such untimeliness was a breach of the requisite standard of care for dentists practicing orthodontics in North Carolina.\nWe now turn to the sufficiency of the evidence to support the Board\u2019s findings and conclusions concerning Naico.\nNaico, a minor child, first presented at petitioner\u2019s office on 5 December 1996, seeking treatment for an overbite and gaps in his teeth. Petitioner, diagnosed Naico as having a class II malocclusion, one hundred percent overbite, and four to six millimeter overjet. Prior to initiating treatment, petitioner took records, including a panorex radiograph, cephalometric radiograph, and trimmed study models. Petitioner admits, however, that he did not take intraoral or facial photographs.\nPetitioner\u2019s initial treatment plan called for the use of a biteplate and orthodontic braces, and a Medicaid pre-authorization form indicated a twenty-four month course of treatment. In May 1998, however, petitioner informed Naico\u2019s mother (Ms. Naico) that Naico\u2019s treatment would require extraction of the upper first premolars. On 26 May 1998, after nine months of treatment, petitioner referred Naico to a general dentist for these extractions. A year later, after twenty-one months of treatment, petitioner became concerned that Naico\u2019s case \u201cwas progressing probably in less than an ideal way\u201d and began considering other possible treatment options, including further extractions and oral surgery. Dissatisfied with the progress her son had made in petitioner\u2019s care, and alarmed at the prospect of further extractions when the gaps in Naico\u2019s teeth were not being closed, Ms. Naico discontinued treatment with petitioner in May 1999.\nAt petitioner\u2019s hearing, the Board presented the expert testimony of Dr. James Kaley, an orthodontist. Dr. Kaley testified that the standard of care for dentists licensed to practice in North Carolina requires an orthodontist to take intraoral and facial photographs prior to initiating treatment and that petitioner breached this standard of care in his treatment of Naico. Dr. Kaley stated that petitioner\u2019s treatment plan was inappropriate in that it failed to correct Naico\u2019s orthodontic problems in a timely manner. Specifically, Dr. Kaley testified that petitioner\u2019s initial treatment plan would never have corrected Naico\u2019s orthodontic problems, that this should have been evident to petitioner from the beginning, and that the standard of care required petitioner to recommend either surgery or the use of a Herbst appliance as the appropriate treatment plan for Naico at the outset. Dr. Kaley also testified that petitioner\u2019s treatment plan failed to address several of Naico\u2019s orthodontic problems, including a missing lower left central incisor and angled left second molar. Dr. Kaley stated that with a proper diagnosis and treatment, Naico\u2019s treatment could have been completed within two to two-and-a-half years. With petitioner\u2019s treatment plan, however, Dr. Kaley did not believe that a satisfactory result could be reached \u201cregardless of time.\u201d\nBased on the testimony and physical evidence presented at the hearing, the Board found that petitioner breached two applicable standards of care with respect to Naico. First, the Board found that the standard of care for dentists licensed to practice in North Carolina requires an orthodontist \u201cto take, or have available, intraoral and facial photographs prior to initiating orthodontic treatment\u201d and that petitioner breached this standard of care by failing to include such photographs in Naico\u2019s treatment records. Second, the Board found that petitioner breached the requisite standard of care for dentists licensed to practice in North Carolina by failing \u201cto formulate an appropriate treatment plan to remedy the problems diagnosed in a timely manner.\u201d\nPetitioner disputes both of these findings. First, petitioner argues that notwithstanding Dr. Kaley\u2019s testimony, the Board lacked substantial evidence to support its finding that petitioner\u2019s failure to include intraoral or facial photographs in Naico\u2019s treatment records breached an applicable standard of care. In support of this contention, petitioner asserts that photographs are not necessary for a proper diagnosis, as they do not show anything that cannot be observed with the naked eye. Petitioner also alleges that a leading treatise on orthodontic care does not list intraoral or facial photographs as a necessary diagnostic tool. Finally, petitioner contends that because Dr. Kaley\u2019s testimony did not address the comparative value of photographs over the diagnostic tools petitioner did employ, Dr. Kaley\u2019s testimony does not constitute substantial evidence in support of the Board\u2019s findings.\nAfter careful review of the record, we cannot say that the Board lacked a reasonable basis for its decision. Dr. Kaley testified that photographs are useful both in initial diagnosis and to record a patient\u2019s initial condition for later reference. Thus, even assuming intraoral and facial photographs have no value as a diagnostic tool, the Board could reasonably have concluded that the standard of care requires their use as a means to track the progress of orthodontic care. Moreover, the absence of testimony concerning the relative advantages of photographs over other diagnostic tools goes only to the weight of Dr. Kaley\u2019s testimony, which is a matter for the Board to decide. See State ex rel. Comm\u2019r of Ins., 300 N.C. at 406, 269 S.E.2d at 565. Similarly, the fact that a learned treatise does not list photographs among the minimum required diagnostic records is not dispositive as to the standard of care. The Board was certainly entitled to reject petitioner\u2019s allegations in light of Dr. Kaley\u2019s testimony. See id.\nNext, petitioner contends that Dr. Kaley\u2019s testimony about the timeliness of petitioner\u2019s treatment of Naico is insufficient to establish the requisite standard of care. Petitioner argues that Dr. Kaley offered his opinion regarding the preferred treatment plans for Naico\u2019s orthodontic problems, not his understanding of what the statewide minimum level of competency requires. This argument, however, mischaracterizes Dr. Kaley\u2019s testimony. Although Dr. Kaley did testify that his \u201cpersonal preference\u201d would have been to treat Naico with a Herbst appliance, he also testified that petitioner\u2019s actual course of treatment failed to correct Naico\u2019s orthodontic problems in a timely manner in violation of the applicable standard of care. Specifically, Dr. Kaley stated that petitioner\u2019s failure to treat Naico either with surgery or with a Herbst appliance resulted in petitioner\u2019s initial adoption of a treatment plan with no chance of success. From this evidence, the Board could reasonably have concluded that petitioner failed to conform to a statewide level of minimum competency applicable to all dentists practicing orthodontics in North Carolina. Thus, the Board\u2019s findings are supported by substantial evidence in view of the entire record and are binding on appeal.\nIII.\nThe final issue presented is whether the Board erred as a matter of law in concluding that petitioner\u2019s refusal to treat Wolfe due to nonpayment constituted \u201cnegligenfce] in the practice of dentistry\u201d within the meaning of N.C.G.S. \u00a7 90-41(a)(12).\nWolfe, a minor child, first presented to petitioner\u2019s office on 24 January 1996, complaining of crooked and crowded teeth. Petitioner diagnosed Wolfe as having a Class I malocclusion, \u201cseverely crowded with overlapping of the maxillary central incisors and mandibular anterior crowding,\u201d and proposed a treatment plan requiring the extraction of four bicuspids following the initial use of orthodontic appliances. Between August 1996 and July 1997, petitioner saw Wolfe in his office on eight occasions, during which time he took records, placed separators, and finally placed orthodontic bands and wires in Wolfe\u2019s mouth. Petitioner delayed the proposed extractions while awaiting Medicaid approval of Wolfe\u2019s case.\nOn 12 August 1997, eleven days after Wolfe\u2019s Medicaid claim was denied, Wolfe\u2019s mother (Ms. Wolfe) consented to pay for petitioner\u2019s orthodontic services, and Wolfe was referred to a general dentist for the extraction of four teeth. By the terms of the written guarantor contract, Ms. Wolfe agreed to make thirty-five installment payments on the first of each month. On 8 October 1997, Wolfe arrived for a scheduled appointment and was advised that she would have to reschedule due to nonpayment. Wolfe rescheduled for 30 October 1997 and was seen on that day after making her October payment. On 26 November 1997, Wolfe was again sent away from a scheduled appointment due to nonpayment. Wolfe did not return to petitioner\u2019s office after this occasion.\nAt petitioner\u2019s hearing, a Dental Board investigator testified that petitioner had stated it was office policy to refuse treatment to patients who owed a balance on their accounts. Petitioner denied having such a policy, but admitted that Wolfe was twice denied treatment due to nonpayment. Dr. Numa Cobb, an orthodontist, testified as an expert witness for the Board concerning the standard of care for dentists licensed to practice in North Carolina. Dr. Cobb testified that the standard of care \u201cvery clearly\u201d requires a dentist to continue to see an orthodontic patient even though there is an outstanding balance on his or her account. According to Dr. Cobb, the standard of care requires a dentist to continue treating a patient who is not making payments unless and until the dentist (1) sends the patient a letter terminating the dentist-patient relationship and (2) provides the patient with an opportunity to find another orthodontist. Dr. Cobb further testified that petitioner\u2019s office \u201cabandoned\u201d Wolfe as a patient when Wolfe was refused treatment due to nonpayment and that this abandonment violated the requisite standard of care.\nBased on the evidence presented, the Board found that the standard of care for dentists licensed to practice in North Carolina requires that \u201conce orthodontic treatment is initiated, the dentist must continue to treat a patient with an outstanding balance until that patient has been formally dismissed by the practice and given a period of time to find another dentist to continue treatment.\u201d The Board concluded that petitioner violated this standard of care by refusing to treat Wolfe because of an outstanding balance on her account. The Board concluded that this violation of the applicable standard of care \u201cwas a dereliction from professional duty constituting negligence in the practice of dentistry within the meaning of N.C.G.S. \u00a7 90-41(a)(12).\u201d\nPetitioner argues, and the Court of Appeals held, that an orthodontist\u2019s rescheduling practices do not involve the \u201cpractice of dentistry,\u201d and thus petitioner cannot be disciplined under section 90-41(a)(12) of the Dental Practice Act. Watkins, 157 N.C. App. at 374, 579 S.E.2d at 515. According to petitioner and the Court of Appeals majority, an orthodontist\u2019s questionable rescheduling practices are more appropriately viewed as \u201cunprofessional conduct,\u201d bringing such practices within the purview of section 90-41(a)(26). Id. at 374-75, 579 S.E.2d at 515 (2003). Section 90-41(a)(26) of the Dental Practice Act provides that the Board may revoke or suspend the license of a dentist who \u201c[h]as engaged in any unprofessional conduct as the same may be, from time to time, defined by the rules and regulations of the Board.\u201d. N.C.G.S. \u00a7 90-41(a)(26). Because the Board\u2019s rules and regulations are silent with regard to rescheduling practices, petitioner argues, the Board lacked authority to discipline him for his refusal to treat Wolfe.\nAt the outset, we agree with petitioner that whether a dentist\u2019s refusal to treat a patient due to nonpayment constitutes \u201cthe practice of dentistry\u201d or \u201cunprofessional conduct\u201d within the meaning of the applicable statute is a question of law subject to de novo review. See Brooks v. McWhirter Grading Co., 303 N.C. 573, 580-81, 281 S.E. 2d 24, 29 (1981). We note, however, that the construction given to a statute by the administrative agency charged with the statute\u2019s enforcement is entitled to due consideration by a reviewing court. Faizan v. Grain Dealers Mut. Ins. Co., 254 N.C. 47, 57, 118 S.E.2d 303, 310 (1961); see also Gill v. Board of Comm\u2019rs of Wake Cty, 160 N.C. 176, 188, 76 S.E. 203, 208 (1912). In the instant case, the Dental Board expressly concluded that petitioner\u2019s refusal to treat Wolfe due to nonpayment \u201cwas a dereliction from professional duty constituting negligence in the practice of dentistry within the meaning of G.S. \u00a7 90-41(a)(12).\u201d Although it is not dispositive, the Board\u2019s construction of the statutory term the \u201cpractice of dentistry\u201d to encompass the refusal to see or treat a patient is persuasive authority for this Court. See Faizan, 254 N.C. at 57, 118 S.E.2d at 310.\nWe also note that our primary task in construing a statute is to effectuate the intent of the legislature. State ex rel. Comm\u2019r of Ins., 300 N.C. at 399, 269 S.E.2d at 561; In re Beatty, 286 N.C. 226, 229, 210 S.E.2d 193, 195 (1974). We have previously identified the \u201cbest indicia of . . . legislative purpose\u201d to be \u201c \u2018the language of the statute, the spirit of the act, and what the act seeks to accomplish.\u2019 \u201d State ex rel. Comm\u2019r of Ins., 300 N.C. at 399, 269 S.E.2d at 561 (quoting Stevenson v. City of Durham, 281 N.C. 300, 303, 188 S.E.2d 281, 283 (1972)).\nApplying these principles, we turn first to the language of the Dental Practice Act. Section 90-29(b) of the Dental Practice Act enumerates thirteen \u201cacts or things\u201d that constitute the \u201cpractice of dentistry.\u201d N.C.G.S. \u00a7 90-29(b). These \u201cacts or things\u201d include not only clinical procedures such as removing stains, extracting teeth, and correcting the malposition of teeth, see N.C.G.S. \u00a7 90-29(b)(2),(3),(5), but also broadly defined managerial and advertising practices, see N.C.G.S. \u00a7 90-29(b)(ll),(12),(13). Specifically, subsection 90-29(b)(ll) provides that a dentist is engaged in the \u201cpractice of dentistry\u201d when he or she \u201c[o]wns, manages, supervises, controls or conducts . . . any enterprise wherein any one or more of the [clinical] acts or practices set forth in subdivisions (1) through (10) above are done, attempted to be done, or represented to be done.\u201d N.C.G.S. \u00a7 90-29(b)(ll). In the present case, it is reasonable to characterize petitioner\u2019s refusal to see or treat a patient as a facet of his management, supervision, control, or conduct of his dental practice. Thus, the language of the Act is amenable to the construction placed upon it by the Board.\nIn pursuing the next two prongs of our inquiry, the spirit and legislative goals of the Dental Practice Act, we need look no farther than the Act itself. The Dental Practice Act expressly declares that \u201cthe practice of dentistry . . . affect[s] the public health, safety, and welfare,\u201d and is therefore \u201csubject to regulation and control in the public interest.\u201d N.C.G.S. \u00a7 90-22(a). The Act further provides that it \u201cshall be liberally construed to carry out these objects and purposes.\u201d Id. In the instant case, we agree with the Board\u2019s assertion that a dentist\u2019s refusal to treat a patient due to nonpayment may directly and adversely affect a patient\u2019s health. This conclusion draws support from the expert testimony of Dr. Cobb, an orthodontist, who stated at petitioner\u2019s hearing that a patient in braces who does not receive follow-up treatment may experience \u201cperiodontal lesions, periodontal disease . . . loose bands, caries beneath the bands, loose brackets, loose wires, [and] wires going into the [t]issue.\u201d Because the Dental Practice Act was intended to guard against such threats to the public health, and because the Act is to be liberally construed to effectuate this purpose, a dentist\u2019s refusal to treat a patient may appropriately be characterized as the \u201cpractice of dentistry\u201d as defined in N.C.G.S. \u00a7 90-29(b).\nPetitioner also argues, however, that even if an orthodontist\u2019s refusal to see or treat a patient constitutes \u201cthe practice of dentistry,\u201d Wolfe had already \u201cvoluntarily terminated\u201d the dentist-patient relationship. Petitioner notes that Wolfe was refused treatment on 8 October and 26 November 1997. In her complaint, however, Wolfe alleged that she \u201chad contacted the office in August or September of \u201997 to tell them [she] did not want to see them anymore.\u201d Because Wolfe had terminated the dentist-patient relationship prior to the incidents complained of, petitioner contends, petitioner owed her no professional duty, and his refusal to treat her cannot constitute \u201cnegligence\u201d in the practice of dentistry under section 90-41(a)(12).\nThe Court of Appeals found this argument persuasive and held that because Wolfe \u201cwas no longer a patient of record\u201d at the time she was refused treatment, petitioner\u2019s failure to treat her could not constitute \u201cnegligence\u201d under section 90-41(a)(12). Watkins, 157 N.C. App. at 375, 579 S.E.2d at 515. We disagree. Notwithstanding petitioner\u2019s allegations, the Board found as a fact that Wolfe was a patient of record at the time she was denied treatment due to nonpayment. Because this finding is supported by substantial evidence in view of the entire record, it is binding on appeal.\nIn her complaint, Wolfe stated that she contacted petitioner\u2019s office in August or September 1997 \u201cto tell them [she] did not want to see them anymore because of financial reasons [and because she] wanted an office in High Point where [she] live[d].\u201d Nevertheless, Wolfe continued to receive orthodontic treatment from petitioner during October and November of that year. From this evidence, the Board could reasonably have concluded that Wolfe had merely expressed her desire to discontinue treatment with petitioner at some point in the future. Alternatively, the Board could reasonably have concluded that Wolfe had changed her mind about terminating the dentist-patient relationship. In any event, the Board possessed \u201crelevant evidence a reasonable mind might accept as adequate,\u201d N.C.G.S. \u00a7 150B-2(8b), to support its conclusion that petitioner\u2019s refusal to treat Wolfe breached a duty to Wolfe and thus constituted negligence in the practice of dentistry'under N.C.G.S. \u00a7 90-41(a)(12).\nMoreover, Dr. Cobb testified at petitioner\u2019s hearing that a telephone call from a patient expressing a desire to discontinue treatment does not terminate the dentist-patient relationship. Instead, Dr. Cobb testified, the dentist-patient relationship continues until a patient is formally released by the dentist. The record contains no indication that petitioner formally dismissed Wolfe from his care prior to his refusal to treat her. Thus, the Board could reasonably have concluded that petitioner\u2019s professional duties to Wolfe survived any attempt on Wolfe\u2019s part to sever the professional relationship. Accordingly, the Board\u2019s determination that petitioner\u2019s refusal to treat Wolfe constituted \u201cnegligence\u201d in the practice of dentistry is supported by substantial evidence in view of the entire record.\nIn conclusion, the Board acted within its authority in determining that petitioner had breached the applicable standard of care in his treatment of Casto. In addition, the Board\u2019s findings of fact and conclusions of law are supported by substantial competent evidence in view of the whole record. Finally, the Board properly concluded that petitioner\u2019s refusal to treat Wolfe because of an outstanding balance on her account constituted negligence in the practice of dentistry within the meaning of N.C.G.S. \u00a7 90-41(a)(12). Accordingly, the decision of the Court of Appeals is reversed and the case is remanded to the Court of Appeals for further remand to the trial court for entry of judgment affirming the Board\u2019s disciplinary order.\nREVERSED AND REMANDED.\n. Petitioner is also licensed in New York, where he practices general dentistry.", "type": "majority", "author": "MARTIN, Justice." } ], "attorneys": [ "The Charleston Group, by Freddie Lane, Jr., for petitionerappellee.", "Ellis & Winters, L.L.P., by Paul K. Sun, Jr.; and Bailey & Dixon, L.L.P., by M. Denise Stanford, for respondent-appellant.", "Allen & Pinnix, P.A., by Noel L. Allen and Angela Long Carter, on behalf of North Carolina State Board of Certified Public Accountant Examiners and North Carolina Board of Architecture, amici curiae.", "North Carolina Medical Board, by Amy Yonowitz and Marcus Jimison, amicus curiae.", "Howard A. Kramer, on behalf of North Carolina Board of Nursing, amicus curiae.", "Womble, Carlyle, Sandridge & Rice, P.L.L.C., by Johnny M. Loper, on behalf of North Carolina State Board of Examiners in Optometry, amicus curiae.", "Young, Moore & Henderson, P.A., by John N. Fountain, on behalf of North Carolina State Board of Examiners of Electrical Contractors and North Carolina State Board of Examiners of Plumbing, Heating, and Fire Sprinkler Contractors, amici curiae.", "North Carolina State Board of Examiners for Engineers and Surveyors, by David S. Tattle, amicus curiae." ], "corrections": "", "head_matter": "PAUL E. WATKINS, D.D.S., Petitioner v. NORTH CAROLINA STATE BOARD OF DENTAL EXAMINERS, Respondent\nNo. 301A03\n(Filed 2 April 2004)\n1. Dentists\u2014 orthodontist \u2014 standard of care \u2014 absence of expert testimony\nThe North Carolina State Board of Dental Examiners was authorized to determine the appropriate standard of care for petitioner orthodontist\u2019s treatment of a patient without expert testimony from an orthodontist, because: (1) there is no per se rule that expert testimony is required to establish the standard of care in disciplinary hearings conducted by professional licensing boards; (2) the fact that the General Assembly did not see fit to make any special provisions for disciplinary actions involving orthodontists suggests that it deemed the standards of care governing the practice of orthodontics to be within the ken of licensed dentists; and (3) a licensee is not denied meaningful judicial review when a licensing board cannot base its findings or conclusions on facts outside the record but has a statutory obligation to reach a reasoned decision based on substantial evidence in view of the entire record.\n2. Dentists\u2014 orthodontist \u2014 suspension of license \u2014 failure to follow timely treatment plan \u2014 failure to take patient photographs\nA whole record review revealed that substantial evidence supported the State Board of Dental Examiners\u2019 decision to suspend the dental license of petitioner orthodontist based upon its findings and conclusions that petitioner breached the standard of care for orthodontists by failing to establish and follow a treatment plan which would address the orthodontic needs of two patients in a timely manner and by failing to take any intraoral and facial photographs of one of those patients because: (1) the Board could reasonably have concluded that petitioner\u2019s delay in initiating treatment, his decision to pursue an initial policy of therapeutic nonextraction, and his eventual decision to extract unilaterally on one side of a patient\u2019s mouth all contributed to an unreasonable delay in one patient\u2019s progress as an orthodontic patient; (2) it fell within the province of the Board to determine whether the delay in a patient\u2019s treatment was attributable to a flawed treatment plan or to patient noncompliance; (3) an expert testified that petitioner initially adopted a course of treatment for the second patient that had no chance of success and that his actual course of treatment of this patient failed to correct the patient\u2019s orthodontic problems in a timely manner; (4) assuming that intraoral and facial photographs have no value as a diagnostic tool, the Board could reasonably have concluded that the standard of care requires their use as a means to track the progress of orthodontic care; and (5) the absence of testimony concerning the relative advantages of photographs over other diagnostic tools goes only to the weight of an expert\u2019s testimony which is a matter for the Board to decide, and the fact that a learned treatise does not list photographs among the minimum required diagnostic records is not dispositive as to the standard of care.\n3. Dentists\u2014 orthodontist \u2014 refusal of treatment \u2014 outstanding balance on patient account \u2014 negligence in practice of dentistry\nA de novo review revealed that the Board of Dental Examiners did not err by concluding that petitioner orthodontist\u2019s refusal to treat a patient due to nonpayment constituted negligence in the practice of dentistry under N.C.G.S. \u00a7 90-41(a)(12), because: (1) although it is not dispositive, the North Carolina State Board of Dental Examiners\u2019 construction of the statutory term \u201cpractice of dentistry\u201d under N.C.G.S. \u00a7 90-41(a)(12) to encompass the refusal to see or treat a patient is persuasive authority for our Supreme Court; (2) it is reasonable in the present case to characterize petitioner\u2019s refusal to see or treat a patient as a facet of his management, supervision, control, or conduct of his dental practice under N.C.G.S. \u00a7 90-29(b)(ll); (3) the Dental Practice Act was intended to guard against threats to public health, and a dentist\u2019s refusal to treat a patient due to nonpayment may directly and adversely affect a patient\u2019s health; and (4) a telephone call from a patient expressing a desire to discontinue treatment does not terminate the dentist-patient relationship, but instead it continues until a patient is formally released by the dentist.\nAppeal pursuant to N.C.G.S. \u00a7 7A-30(2) from the decision of a divided panel of the Court of Appeals, 157 N.C. App. 367, 579 S.E.2d 510 (2003), affirming a judgment signed 5 April 2002, by Judge David Q. LaBarre in Superior Court, Wake County. Heard in the Supreme Court 17 November 2003.\nThe Charleston Group, by Freddie Lane, Jr., for petitionerappellee.\nEllis & Winters, L.L.P., by Paul K. Sun, Jr.; and Bailey & Dixon, L.L.P., by M. Denise Stanford, for respondent-appellant.\nAllen & Pinnix, P.A., by Noel L. Allen and Angela Long Carter, on behalf of North Carolina State Board of Certified Public Accountant Examiners and North Carolina Board of Architecture, amici curiae.\nNorth Carolina Medical Board, by Amy Yonowitz and Marcus Jimison, amicus curiae.\nHoward A. Kramer, on behalf of North Carolina Board of Nursing, amicus curiae.\nWomble, Carlyle, Sandridge & Rice, P.L.L.C., by Johnny M. Loper, on behalf of North Carolina State Board of Examiners in Optometry, amicus curiae.\nYoung, Moore & Henderson, P.A., by John N. Fountain, on behalf of North Carolina State Board of Examiners of Electrical Contractors and North Carolina State Board of Examiners of Plumbing, Heating, and Fire Sprinkler Contractors, amici curiae.\nNorth Carolina State Board of Examiners for Engineers and Surveyors, by David S. Tattle, amicus curiae." }, "file_name": "0190-01", "first_page_order": 222, "last_page_order": 241 }