DENTAL DANGERS: Local dentist's invisible complaint file underscores dental board's shortcomings

Over three decades, more than a dozen patients have claimed that one dentist’s shoddy work left them with issues varying from bone loss and excessive drooling to ill-fitting teeth or other problems. Some have stated it would take thousands of dollars and multiple corrective procedures to fix the damage they allege the dentist inflicted on their mouths. Meanwhile, state dental regulators are of little help to the rest of us.

Dr. Robert Tupac, who practiced in the Los Angeles area before opening a Bakersfield office, has had at least 18 lawsuits and small claims cases filed against him citing problems with his work. Even the California Attorney ­General’s Office, on behalf of the Dental Board of California, the state agency that licenses and polices dentists, has alleged that Tupac’s work was grossly negligent.

But a potential patient searching for competent dental care would never know about many of Tupac’s alleged professional shortcomings — or those of any other California dentist — without undertaking extensive and often difficult research. That’s because the Dental Board makes dentists’ complaint files almost completely inaccessible to the public, an agency practice that severely limits the state’s patient protection system’s value to consumers. The Dental Board and state law also don’t mandate that all dentists who are on probation notify their patients.

In the course of an extended look into Tupac’s professional career The Californian found:

• The Dental Board website makes no mention of Tupac’s civil suits on his license profile.

• The Dental Board won’t say how many complaints consumers have made against Tupac, or any other dentist.

• It is difficult to judge the outcome of the civil lawsuits against Tupac because the cases do not detail terms of settlements.

Complicating The Californian’s efforts to learn more about Tupac’s work is the reluctance of his patients to speak about their specific situations or lawsuits. Dental malpractice attorneys say settlements usually include nondisclosure terms, making it difficult to know the outcome of allegations against Tupac filed in Los Angeles, Kern and Ventura county courts.

Some of the court files involving the dental claims against Tupac indicate a settlement was reached but provide no details. Others show a case was dismissed. As of early July, four civil cases accusing Tupac of dental wrong­doing were still pending in Kern County Superior Court.

At hearings in a state government building last year in downtown Los Angeles, the state Attorney General’s Office painstakingly tried to establish that Tupac was careless in his treatment of two patients, resulting in pain and great expense. The Dental Board alleges Tupac failed to appropriately plan for the patients’ care, altered their treatment records and allowed an employee to do work outside the scope of her license, including removing a patient’s implant.

The Dental Board’s accusation against Tupac aims to revoke or suspend his dental license. The board doesn’t disclose details about the complaints made against any dentist, so it’s unclear how many patients or practitioners complained about Tupac’s work in the past.

But the painful details of the civil cases show that the negligence accusation against Tupac represents only a fraction of the patients’ dissatisfaction leveled against the Bakersfield-practicing dentist.

Tupac’s attorney has com­mented briefly on the Dental Board’s claims but Tupac himself has not addressed the accusations, though he provided contact information for several satisfied patients. In January, Tupac agreed to take a list of questions from a reporter about the cases against him and his personal and professional history, but never answered them.

Instead, his attorney released a statement that accompanies this series.

The Dental Board’s accusation against Tupac is inching toward closure after 21⁄2 years. His hearing is scheduled to resume Monday and is expected to last two weeks.

An administrative judge will offer a proposed decision after the conclusion of the hearing. But ultimately, the fate of Tupac’s license will be decided by members of the Dental Board, which is comprised of eight dentists, five members of the public, one registered dental hygienist and one registered dental assistant. The board members can adopt the judge’s recommendation or change it.

INFORMATION LIMITED

A natural place for people to look up a dentist is the Dental Board of California’s website.

But the website doesn’t offer a record of complaints made about a particular dentist, or a history of malpractice suits he or she has faced. In situations where the site does note a malpractice judgment, no case details are provided.

The public has no way to determine whether other patients have complained about a dentist. Additionally, Dental Board officials refuse as a matter of policy to discuss specific complaints, adding another layer of obfuscation.

The Dental Board’s site shows that Tupac’s license is current and the agency has filed an accusation against him — alleging he negligently treated two patients — and seeks to revoke or suspend his license. It does include a copy of the accusation plus records of when it was first filed — Feb. 1, 2012 — and when amendments were made.

The accusation stems from complaints two patients and one dentist made to the board about Tupac. But there is no way to know if other patients ever complained to the board about Tupac.

The site doesn’t list any information about the history of malpractice allegations against Tupac.

Dental Board staff said dentists without professional liability insurance are required to notify the board of any settlement, judgment or arbitration award of $3,000 or more for death or personal injury damages against them.

State law also requires insurers to report dentists’ settlements or arbitration awards of more than $10,000 to the board within 30 days.

Kim Trefry, the Dental Board’s enforcement chief, said the board only posts notices of civil malpractice judgments “reported to us after adjudication or arbitration.” That does not include settlements reached outside of court.

When the board does disclose information about malpractice awards along with a dentist’s license, it’s limited to cases where judgment awards are more than $30,000, or more than $3,000 if a dentist doesn’t have professional liability insurance.

This is different from how the Medical Board of California operates. For most physicians, the Medical Board will post notice of malpractice judgments, arbitration awards or settlements of more than $30,000, if a doctor has three within a 10-year period. For physicians who practice in high-risk specialities such as obstetrics, orthopaedic surgery, plastic surgery or neurological surgery, the board posts notice if they have four in 10 years.

The different reporting requirements are laid out in state law.

WEIGHING LAWSUITS

Dental malpractice attorneys say it is difficult to read too much into malpractice cases like the ones against Tupac without knowing their outcomes.
“If you’re looking at it from the standpoint of a consumer, it’s hard to get information about what really transpired in any (malpractice) cases,” said Todd Osborne, a Santa Cruz attorney who has represented at least two patients in lawsuits against Tupac.

“Part of what the doctors are buying (in these settlements) is peace of mind that somebody’s not going to run out and post a bunch of stuff on Yelp,” Osborne said.

Attorneys said dental malpractice cases are often settled before they go to trial because trials are risky and expensive.

Jurors may not sympathize with a patient who spent tens of thousands of dollars on dental work. And, in the end, it’s jurors with neither medical nor dental backgrounds deciding whether a dentist violated the community standard of care, Osborne said.

“There’s no independent book that they can consult on what is the standard of care and what isn’t,” he said.

Specialty dentists said while prosthodontists and other specialists do handle more complex cases, their additional training should prepare them.

“That’s why (prosthodontists) have the three years of training after dental school, just to handle the difficult cases,” said Dr. Edwin Zinman, a periodontist and San Francisco-based dental malpractice attorney.

Zinman said most of the lawsuits he handles are against general dentists and it’s unusual he sees a case against a prosthodontist.

Neither the American Dental Association, The Dentists Insurance Company, the California Department of Insurance nor the California Department of Managed Health Care maintain records on patient risks with specialty ­dentists.

Much like medical specialities such as obstetrics, outcomes vary on patient health, genetics and a host of other factors.

The Dentists Insurance Company does keep information on the number of lawsuits filed against TDIC policy­holders, whether general practitioners or specialists, but that data is proprietary.

Separate from the courtroom, disputes between dentists and patients may be resolved through peer review, a process run by the California Dental Association in which local dentists weigh the merits and evidence of claims.

“The number of cases statewide has remained steady over the past four years since the administrative processes were centralized at CDA — between 215 and 300 cases per year,” Alicia Malaby, director of communications for the California Dental Association, wrote in a November 2013 email.

“Approximately 15-20 percent of cases initiated involve treatment by specialists.”

Tupac’s past

Tupac is a board-certified prosthodontist, an accreditation not easily achieved. Prosthodontics, the specialty of replacing and restoring teeth, is one of nine specialities recognized by the ­American Dental Association.

To become a board-certified prosthodontist, a dentist must first finish a dental degree and then complete a minimum three-year graduate program in prosthodontics. He or she then takes one written and three oral exams, which include presenting treatment records for specific treatment areas, said Dr. Thomas D. Taylor, executive director of the American Board of Prosthodontics. The dentist must also complete scenario-based exams on topics selected by the American Board of Prosthodontics.

Tupac, who is 65 according to public records, was licensed by the Dental Board in 1974 and his license is set to expire in October. Woodland Hills attorney Robert McCulloch, a well-known dental malpractice attorney who has represented at least five patients in civil lawsuits against Tupac, said the dentist was well-regarded at one point.

“Dr. Tupac had a very good reputation earlier in his career,” McCulloch said.

Though his reputation was good, Tupac began accumulating civil lawsuits filed against him by displeased patients in Los Angeles.

Civil lawsuits against Tupac from the 1980s and 1990s indicate he practiced in Beverly Hills.

Those legal troubles were compounded in the early ’90s when Tupac fell under suspicion following the death of his wife, Marianne.

On Feb. 13, 1991, Tupac reportedly found Marianne with her head under water in the bathtub of their Westwood home. According to an autopsy report, Tupac told investigators Marianne might have overdosed on sleeping pills.

But a supplemental autopsy report later concluded heart disease, drowning, strangulation and suffocation were all possible causes of her death.

“As long as (strangulation and suffocation) have not been excluded, and given the unusual circumstances of this unwitnessed and unexpected death, Mrs. Tupac’s death must be medicolegally considered a homicide,” a supplemental autopsy report said.

Police later searched Tupac’s home and office, according to the Los Angeles Times.

In 1992, the Times reported that Tupac and his new wife, his office manager, were summoned to speak to a grand jury about the case, but did not testify after Tupac invoked his Fifth Amendment right against self-incrimination.

The Los Angeles County District Attorney’s Office declined to file charges in the case in 1992. The Times quoted a deputy district attorney as saying there were “inconsistent positions among three different coroners’ offices, and the problem was establishing it was death by criminal agency.”

Another supplemental autopsy report filed in 1993 concluded Marianne “was suffocated or drowned.”

Following Marianne’s death, the civil suits stemming from Tupac’s dental work continued. Some suits adopted a different tone, bringing up Tupac’s personal problems outside of his dental office.

A filing in a civil suit filed by Joann Komin in Los Angeles County in 1996 noted Tupac had legal disputes with his former mother-in-law, “a number of malpractice actions” and Tupac was suffering from an infection while he treated the patient. (Tupac filed his own medical malpractice lawsuit against Cedars-Sinai Medical Center and two physicians in 1996.)

“(Komin) only wishes she would have learned about (Tupac’s) litigation history before he lulled her into thinking that he was a competent practitioner,” one filing in the case said.

Another suit filed in Los Angeles County the following year alleged Tupac was “in substantial financial difficulty” because his home had been damaged by an earthquake, he had incurred “significant legal expenses” and he was performing less work than in other years. The suit also mentioned “turmoil and change” in office personnel.

“Robert Tupac was under significant strain and emotional distress ... and knew that such emotional strain and distress was detracting from his ability to render professional services in accordance with the standards of the community,” the suit said.

Coming to Bakersfield

Bakersfield dentist Richard ­Casteen met Tupac in the mid-1990s through a continuing education course at the University of Southern California. Tupac was one of the teachers of the odontic seminar.

Casteen invited Tupac to practice in his office in Bakersfield, but Casteen soon became disenchanted with Tupac.

“He refused to take the continuing education course that I requested, that I thought he needed, in oral surgery and implantology,” Casteen said.

Casteen said Tupac worked at his practice for about a year and a half.

After leaving Casteen’s practice, Tupac rented space in the office of prosthodontist Leland Yeoman, now retired. Yeoman, who practiced in Bakersfield for nearly 40 years, said he was disappointed by Tupac’s dentistry.

“I would refer patients to him initially and then they had a lot of complaints,” Yeoman said.

Yeoman said he assumed Tupac’s work would be excellent because Tupac was a former president of the Pacific Coast Society of Prosthodontists.

“He (had) all the ability in the world to do excellent care but it wasn’t coming out this way,” Yeoman said.

Yeoman said he couldn’t remember exactly when he and Tupac parted ways but that it was in the early 2000s. City records show Tupac first received a Bakersfield business license in 2004.

“We haven’t had words or anything. ... We were just so glad to dissolve the relationship that nothing has been said,” Yeoman said.

Tupac’s business at 5060 California Ave., Suite 170, opened Jan. 1, 2004, according to city records, and the license has been renewed annually since.

His office is on the ground floor of Stockdale Tower, Bakersfield’s tallest building.

A statement from Tupac’s attorneys said the dentist “gradually shifted his full-time practice to Bakersfield” because of “the need for prosthodontic services in the Central Valley.”

Through his attorney, Jason Friedman, Tupac expressed surprise and disappointment at Yeoman’s and Casteen’s statements.

Friedman wrote in an email that Tupac was “disappointed in Dr. Yeoman’s comments as he merely leased space from Dr. Yeoman while building his own practice.

“It should be noted that Dr. Tupac first met Dr. Yeoman over 25 years ago when (Tupac) was the Chair of the California Dental Association Prosthodontic Peer Review Committee. At that time the Peer Review Committee found against Dr. Yeoman in a dispute (Yeoman) had with a patient,” Friedman wrote.

“Dr. Tupac can only speculate that Dr. Yeoman continues to bear some animosity from that experience.”

Friedman wrote that Tupac had not worked with Casteen for almost 15 years and called the dentist’s comments “puzzling.”

“During the time they worked together, Dr. Tupac provided a crown in Dr. Casteen’s own mouth, at Dr. Casteen’s request. If Dr. Casteen did not have confidence in Dr. Tupac’s work, one would not expect him to entrust his own dental treatment to Dr. Tupac,” Friedman wrote.
Casteen declined to respond to Tupac’s assertion.

Yeoman also declined further comment.

Accusation origin

The Dental Board’s accusation originates with complaints from two patients — Sheila Rios and Rick Lawhon — and Bakersfield dentist Dr. Robert Reed.

In the case of Rios, the Dental Board alleged Tupac unnecessarily removed all of her teeth in a roughly eight-hour procedure and placed 10 implants in her mouth under oral sedation, even though he told her he would do the work while she was under general anesthesia.

The accusation also said Tupac billed Rios for 11 implants even though he only gave her 10.

At the administrative hearing in Los Angeles last fall, dentists testified Rios’ implants were poorly placed. They said Rios’ bone resorbed — or melted away — and that when her upper implants were removed, the implants were not fully encased in bone and easily came out of her mouth with just finger pressure.

Rios testified she did not like the permanent teeth Tupac gave her, that the top ones were bulky and the bottom ones too small. She said she accepted them because her temporaries had “crumbled” and a Tupac employee told her the only other option was for her to go home without teeth.

Once the permanent teeth were in, Rios noticed the dental fixtures did not have molars — back teeth.

“It had been a long, grueling ordeal,” Rios testified last spring.

In Lawhon’s case, a dentist who reviewed his treatment for the Dental Board said Tupac didn’t consider factors that contribute to implant failure — such as Lawhon’s high blood pressure and heavy smoking — and develop alternative treatment plans.

Tupac removed Lawhon’s remaining teeth and gave him 12 implants, according to the accusation.

The board’s expert testified Tupac’s patient records for Rios and Lawhon appeared to have been altered. A dentist who reviewed the case on behalf of the Dental Board testified that the way Rios’ records were written is “totally inconsistent and I must say, self-serving” to Tupac’s claim that he planned for her case.

Lawhon testified he had to make repeated trips to Tupac for repairs to his temporary and permanent fake teeth.

“Pieces were breaking off and he was going back there all the time,” Lawhon’s wife, Cindy Lawhon, testified last fall.

Cindy Lawhon said every time her husband saw Tupac’s smiling face on television commercials, “it tore at him.” She testified she told her husband filing a complaint with the Dental Board was all he could do to make sure what happened to him didn’t happen to anyone else.

Lawhon did not return several phone messages requesting an interview. Rios and her husband declined to be interviewed.

Reed reported his concerns to the Dental Board in 2009, stating he noticed concerning patterns when he filled in for Tupac while the prosthodontist was on medical leave. (Civil case records indicate Tupac was undergoing treatment for cancer in 2009.)

“Treatment rendered on the majority of these patients was well below the standard of care in his community and in my opinion any community in California,” the accusation states, quoting Reed’s complaint.

Reed noticed “poorly placed implants, poorly placed prosthesis and comments by patients seen that much of (the dental) work (was) done by” his staff members who were not dentists. (One of Tupac’s former dental assistants later testified she did work outside the scope of her license while employed by him, including removing an implant.)

Reed also wrote he learned of other patients who “had been seen in other offices with substandard care.”

When he testified at Tupac’s hearing in February 2013, Reed acknowledged he had seen only two of the seven patients he referenced in his complaint to the board. Reed testified he also talked to several other dentists who’d treated former Tupac patients.

“We collectively felt the care was substandard in our community,” he said.

In their statement to The Californian, Tupac’s attorneys blamed the Dental Board accusation on their client’s competition.

Although Reed declined to comment for this article, two dentists called as witnesses for the board testified he has a good reputation.

As the Dental Board’s allegations unfolded in the hearing, Tupac remained mostly silent. He attended the hearing last spring but was absent when it continued in the fall following injuries from a car accident.

At the hearing, Tupac attorney Friedman hinted as he questioned witnesses that Reed had a falling-out with Tupac. Friedman also pointed out that much of Rios’ dental repair work — done after her treatment from Tupac — also failed.

While the Dental Board, via the Attorney General’s Office, has made a case that Tupac didn’t properly plan for the treatment of patients and his work failed to measure up to dental standards of care, Friedman has consistently said Tupac will be cleared by the evidence when the hearing concludes.

“The facts will vindicate Dr. Tupac, and he will continue to pursue his greatest joy, which is to provide prosthodontic services to the people of the Central Valley,” a statement from Tupac’s attorneys said.

Steps for patient care

Before patients step into any dentist’s office or commit to costly procedures, it’s up to them to dig into the dentist’s past.

The Dental Board’s disciplinary guidelines for dentists and dental workers licensed by the board list 14 standard conditions of probation, including obeying all the laws, providing quarterly reports and complying with the board’s probation program.

Requiring dentists to notify patients that they are on probation is not one of them.

That’s something that Tina Gomes has been trying to change for years. The San Fernando Valley woman said she was spurred by her own horrible dental experience to find out how the Dental Board could better protect patients.

“We can choose our dentist but we’re not really choosing our dentist if the dentist isn’t revealing his or her actual harmful pattern,” she said.

She’s been pushing for a law requiring dentists to notify patients at their office if the practitioner is being disciplined by the Dental Board.

Gomes said she has spoken with state Sen. Marty Block, D-San Diego, who sits on the Senate’s Business, Professions and Economic Development Committee, about the proposal. A spokeswoman said Block’s office did not carry any such legislation this year and would not know if it would carry legislation like that until ­January.

Julie D’Angelo Fellmeth, the administrative director for the Center for Public Interest Law at the University of San Diego School of Law, said it isn’t easy to change the way bodies like the Dental Board regulate professionals.

The Dental Board is one of 20 healing arts boards in the California Department of Consumer Affairs.

Fellmeth, who has long campaigned for changes to the Medical Board, said the best time to attempt reform in how a board works is when the law that creates the board is about to expire — a time known as sunset review.

It’s a period when the Legislature evaluates the board as the law that authorizes a particular board nears expiration.

“The most likely time to target a particular board is when their existence is at stake,” Fellmeth said.

The Dental Board’s sunset review window is just beginning to open. The California law authorizing the board expires Jan. 1, 2016.

Dental Board staff is working on a report about the board — based on a questionnaire sent by the ­Legislature — which is due to the Senate Business, Professions and Economic Development Committee by Nov. 1. The board’s members will discuss the report when they meet in Sacramento on Aug. 25 and 26.

Public comments are allowed at the meetings — people who can’t attend in person can comment by sending a letter or email to the board before the meetings. Public comments will also be taken during the legislative hearings next year.

Apart from the sunset review period, Fellmeth said there’s one other promising time to push a board for change — when scandal strikes.

“When there’s a media frenzy or scandal, that is an opportunity to jump,” she said.

This article was originally published in The Bakersfield Californian.