BY RACHEL COOK Californian staff writer firstname.lastname@example.org
In 2007, Bakersfield dentist Dr. Robert Tupac reassured a concerned patient not "to worry about a thing, I wrote the book on (dental) implants," according to an accusation filed on behalf of the California Dental Board.
But according to that newly filed document, Tupac was negligent in a litany of painful-to-read ways.
Submitted by the state Attorney General's office, it details the complaints of two patients and a dentist who stood in for Tupac while he was on medical leave.
"Treatment rendered on the majority of (Tupac's) patients was well below the standard of care in his community and in my opinion any community in California," the other dentist, referred to as R.R., wrote in his 2009 complaint.
The dentist also reported that one of Tupac's employees said Tupac was altering records because he was being sued by at least two patients, according to the accusation.
The accusation filed Jan. 10 is the third revision of a document first filed Feb. 1, 2012. Tupac's license is still current, according to the Dental Board's website.
Tupac's Stockdale Tower office was open Thursday afternoon, but a woman at the front counter said the dentist is not speaking to anyone about the accusation.
Patients S.R. and R.L.
The accusation alleges Tupac made multiple errors in his treatment of a woman identified as Patient S.R. and a man referred to as Patient R.L.
Tupac recommended "full mouth teeth extraction and ... implant reconstruction" when the woman came to him in November 2005 with some teeth missing and others "severely broken down."
"Many of Patient S.R.'s teeth could have been saved by performing crown lengthening and prosthetic restoration," the accusation says.
In July 2007, Tupac told the woman the surgery would be done under general anesthesia and had her sign a consent form, reassuring her not "to worry about anything" and that she wouldn't "feel a thing."
But that same month, Tupac removed all but eight of the patient's teeth with oral sedation instead of general anesthesia, according to the filing. He left the broken root of one tooth in place.
"(The woman) endured pain for approximately eight (8) hours while seated in the dental chair," the accusation says.
The document goes on to say that, "The teeth extraction and immediate placement of implants were made without regard to quality, quantity or location of the supporting bone.
"The provisional prosthesis placed by (Tupac) was ill-fitting, massive, bulky and the improper size."
The woman returned to the dentist multiple times with problems and pain with the provisional prosthesis, officials allege. At one point, she asked Tupac if a bad odor she noticed could be due to an infection in her mouth. He told her that wasn't the case.
In February 2008, the woman was fitted for permanent bridges that she noticed left gaps between her gums and teeth.
When the woman refused to sign a consent form allowing Tupac to place the bridges, he sent in a dental assistant who told the patient that she wouldn't have any teeth if she didn't sign the form, the accusation says. The patient signed the form and the dentist cemented the bridges.
The woman later told the dentist that gaps in the dental work allowed a lot of food to become trapped, that the threads from her implants were visible through her gums and the crowns "were too wide and bulbous for her mouth."
"(Tupac) blamed her, claiming she had poor oral hygiene," according to the accusation.
The woman consulted other dentists from 2008 to 2011. They found multiple problems with Tupac's work, including that many of the woman's teeth could have been saved, "the implants were placed without care and diligence to provide a minimal amount of bone around the implants," and the implants were too big and positioned wrong, the filing says.
"(One dentist) determined that all of the bone loss and the subsequent treatment after the placement of the implants by (Tupac) altered (the woman's) facial appearance," it says.
Eventually the woman needed all of the implants removed and "several follow-up surgeries."
The woman filed a complaint with the Dental Board.
The Dental Board's accusation alleges that Tupac or his employees forged the woman's signature on a consent form for implant surgery and that the woman was never given a form consenting to oral sedation during the surgery.
The accusation also alleges Tupac billed the woman for 11 implants though he only gave her 10, causing her to pay him an extra $1,750.
The accusation lays out the case of another patient, identified as R.L. Tupac allegedly failed to take into account the man's smoking habit and blood pressure that could preclude him from implants, and removed his remaining teeth and put in implants in August 2007. The man "was unhappy and dissatisfied" with implants, which crumbled and broke, the accusation says.
After repeated visits to Tupac, the man went to another dentist.
"From August 2009 to September 2010, (the other dentist) repaired both upper and lower (hybrid dentures) numerous times replacing missing teeth, repairing cracked acrylic, every week a different problem," the accusations alleges.
That patient also filed a complaint with the Dental Board.
Another dentist filed a complaint in 2009 after filling in at Tupac's office. He noted the poor care and said one of Tupac's dental assistants asked him to cover up for Tupac.
According to the other dentist, also identified as R.R., the woman told him that Tupac altered records because he was being sued and that he asked employees to do procedures they were not "legally qualified to do."
"I take no pleasure in (reporting this) but feel it is the right thing to do," the complaint says.
The Dental Board document asserts that Tupac had registered dental assistants do work they were not allowed to do.
At one point, a patient came into the office with a loose implant while Tupac was at his Beverly Hills office. Via phone, Tupac told a dental assistant to send the woman to another dentist for anesthesia and then have her return to his Bakersfield office so the dental assistant could remove the implants following his instructions over the phone. The dental assistant did as she was told and removed the implant, which is outside the parameters of her own license.
Tupac later let that dental assistant go and asked her to sign a separation agreement not to discuss "office business" in return for several thousand dollars, the accusation said. She turned down the offer.
According to the accusation, another dental assistant did most of the work on Patient R.L. when he had problems with his implants.
"(She) replaced the implants, caps and screws attached to the implants, as needed. (Tupac) would step into the operatory, but it was almost always (the assistant) who was doing the dental work)," the accusation says.
The accusation lays out numerous causes "for discipline" against Tupac, including gross negligence, altering patient records, aiding and abetting an unlicensed person to practice dentistry, incompetence and obtaining fees by fraud. The document requests that the Dental Board revoke or suspend his license and pay restitution to Patient R.L.
The Dental Board issued Tupac's dental license in 1974. The board's website does not show any previous disciplinary actions against him.
Russ Heimerich, spokesman for the California Department of Consumer Affairs, said that after an accusation is filed, an administrative hearing is held, though some cases are settled before the hearing.
After the hearing, the judge will render a proposed decision but the final decision lies with the Dental Board.
Heimerich urged people to check their dentist's license and to file a complaint if they have an issue with their provider.
Dentist licenses can be checked at www.dbc.ca.gov/verification/license_verification.shtml.