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BY RACHEL COOK Californian staff writer email@example.com
LOS ANGELES -- A periodontist testified Wednesday that Dr. Robert Tupac was grossly negligent and failed to properly plan his treatment of two complex patients.
Dr. Victor Pineschi's testimony and cross-examination took up the entire seventh day of a hearing on allegations laid out in the Dental Board of California's accusation against Tupac, a well-known Bakersfield dentist.
Tupac faces a long list of accusations filed by the state Attorney General's office on behalf of the state dental board. They include not developing appropriate treatment plans, using wrong-size implants and poorly positioning them, allowing dental assistants to do work outside the scope of their licenses and altering patient records.
Pineschi, a Los Angeles-area periodontist, reviewed records and statements regarding Sheila Rios of Squaw Valley and Rick Lawhon of Bakersfield for the dental board. Both patients complained to the board about their treatments from Tupac.
Pineschi testified that dentists must correctly plan and place a patient's dental implants including examinations, assessing the quality and quantity of bone, and making a surgical stint so the provider knows exactly where to place an implant.
"Without proper treatment planning it's like trying to get from Santa Monica to Boston without a road map," he said.
In Sheila Rios' case, Pineschi said Tupac's records indicate his treatment planning fell short. He said a CT scan -- an X-ray that gives 3-D images of a patient's mouth -- was needed in a complex case like Rios', but he saw no such scan in Tupac's records.
"This wasn't one mistake, this was numerous errors" added on top of each other, Pineschi said.
He said he did not see in any phase of Tupac's treatment where Rios' aesthetic concerns were addressed. Her prosthesis was not only displeasing, but also had open margins, he testified.
He also hammered Tupac's placement of Rios' implants, saying they obviously went through the bone and into tissue.
He said Tupac admitted that Rios' teeth were hard to remove, and that he had to compromise her bone and break off teeth. Pineschi said Tupac should have aborted the procedure "when he realized he was in trouble taking the teeth out."
Echoing witnesses who testified Monday and Tuesday, Pineschi said Tupac's removal of all of Rios' teeth was not warranted.
"If this was someone in my family, I never would have taken those teeth out," he said.
Among his criticisms of Tupac's work, he also said a dentist has a duty to inform a patient if a tooth root is left in her mouth because it can form an abcess or cyst. Pineschi pointed out two roots -- one in the upper right jaw and one in the lower left jaw -- visible in Rios' mouth in an X-ray taken after Tupac removed all her teeth and replaced them with implants. Pineschi observed that the root in her upper jaw was touching an implant.
One of the allegations in the complaint against Tupac is that he failed to tell Rios about one of the tooth roots left in her mouth.
In Lawhon's case, Pineschi also faulted Tupac's planning, saying he didn't develop alternative treatment plans given the patient's heavy smoking, high blood pressure, alcohol consumption and bruxism -- excessive grinding of teeth.
"All of those contribute to implant failure and must be taken into account" before developing a treatment plan that relies so heavily on implants, Pineschi said.
The dentist testified that he had no problem with Tupac's actual implant placement in Lawhon's case, but questioned whether implants were the right treatment.
Pineschi also found fault with Tupac's records for both Lawhon and Rios.
He said the way Rios' records are written is "totally inconsistent and I must say, self-serving" to Tupac's claim that he planned for her case.
Pineschi's testimony lasted into the afternoon, and Tupac's attorney, Jason Friedman, didn't began his cross-examination until after 2 p.m.
Friedman pointed out that Pineschi's reports never noted he couldn't open CDs provided to him by Tupac that related to the treatment of Lawhon. Pineschi testified that the contents of the CDs were not important to his review and forming his opinion in the case.
Friedman said that a second set of initials appears on Lawhon's chart from Tupac's office, including on an entry for the extraction of seven of Lawhon's teeth. Friedman asked Pineschi if he knew another dentist practiced at Tupac's office. Pineschi said he did not, and he never asked for clarification on whom the other initials belonged to.
During Friedman's cross-examination, Pineschi testified he received a copy of Lawhon's records from the patient and a copy from the dental board, and noticed that dates were overwritten in one set of records. He admitted Friedman's point that one reason for the overwriting might be copying issues.
But Pineschi said a provider shouldn't give out records with overwriting because it could create confusion.
The hearing finished for the day about 4:15 p.m. with the remainder of Friedman's cross-examination still pending.
Although Pineschi will not be back on the stand until next week, the hearing resumes at 11 a.m. Thursday at the downtown Office of Administrative Hearings on West 4th Street.