State Accuses Dental HMO of ‘Shoddy’ Care

In a scathing review of one of California’s largest dental HMOs, state regulators Friday accused Western Dental Services of providing “shoddy, dangerous” medical care and showing a “contemptuous disregard” for patients, many of whom are poor or speak little English.

“While this type of assembly line operation may be perfectly acceptable in the meatpacking industry, it has absolutely no place in the practice of dentistry,” a lawsuit by the state Department of Corporations declares.

Among the examples cited: A 64-year-old diabetic patient who was on eight medications had 23 teeth extracted in one visit with no clearance from his physician.

The charges were filed with the court Friday as part of a lawsuit filed in April in which the state agency is suing Western Dental to place the Garden Grove company into receivership. The state is also seeking a $3-million fine against the dental HMO, which has 357,000 members throughout California.

It is the largest fine ever sought by the state against an HMO, and the first time California has attempted to place a health plan in receivership--a maneuver to effectively replace its management.

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The state accused Western Dental of operating a “cost-efficient, mass-production, low-quality dental mill” at its chain of dental clinics in which doctors were encouraged to overtreat patients in order to maximize profits.

“The papers we are filing today tell a chilling tale of consistent disregard for quality of care and patient health,” Corporations Commissioner Keith Bishop said.

Western Dental, which is partly owned by Dr. Robert Beauchamp Jr., a now-retired dentist, operates 100 clinics throughout California. The clinics, which use the advertising slogan “Dr. Beauchamp, the Credit Dentist,” often are in mini-malls in lower-income neighborhoods.

His father, Robert Beauchamp, built a reputation as a maverick dentist in the 1940s and ‘50s by advertising heavily--a practice then frowned on. He built clinics in low-income neighborhoods, letting patients pay their bills on installment without charging interest. That business flourished and later became part of what is now Western Dental.

In a statement from Western Dental President Robert C. Schur, the company said regulators “acted prematurely in their rush to litigation on this matter.” The company would not respond to questions.

Schur said the company has sent a written rebuttal to the Department of Corporations’ medical survey “which effectively disputes the DOC audit findings, demonstrating flaws and mistaken perceptions.” The state audit, Schur said, “relied on a few specific examples to draw general conclusions that do not fairly or fully represent our services.”

But Bishop said Western Dental management routinely overrode quality review procedures and personnel “in order to increase revenue through overtreatment and inadequately sequenced treatment.” In the process, the state said, the company’s owners raked in “enormous profits.”

The crackdown comes as California’s powerful managed care industry, and the state regulators who oversee it, are coming under heavy criticism from patients rights advocates and legislators.

Some patients rights groups accused the agency of being slow to act. And they questioned whether the timing of the state’s disclosure of the explosive charges--three days before Bishop faces a crucial confirmation vote Monday by a state Senate committee--was politically motivated.

“For almost 10 years these abuses at Western Dental have gone on, and the Friday before the confirmation hearing, the public gets to see these allegations,” said Jamie Court, a spokesman for Consumers for Quality Care, a Los Angeles-based organization affiliated with consumer activist Ralph Nader. “This is a reflection of how woeful the state of HMO regulation is in California.”

But Peter Kezirian Jr., the agency’s general counsel, said politics were not involved. “We’ve been at this thing with Western for seven months, and if we could have done it earlier, we would have.”

The state’s lawsuit, filed in Los Angeles Superior Court, notes that as early as 1988, state health investigators found “unacceptable” levels of medical care at Western Dental clinics. Subsequent state medical surveys in 1990, 1992, 1994 and 1997 also found significant problems with Western’s dental care. Of the most recent survey, completed in January, the state notes in its court filing:

“Amazingly, this survey found the same core problems: dental work done without justification, excessive treatment per visit, lack of appropriate periodontal charting and inadequate quality-of-care control.”

The complaint cited other cases, including a patient with a known medical condition who was given medication inappropriate to his medical condition, and a patient who suffered nerve damage, permanent pain and hearing loss as a result of “incompetent” teeth extraction and failure to treat a sinus infection.

Kezirian noted that Bishop has only headed the agency for a year. He said regulators had tried for years to get Western Dental’s owners to correct problems. “The corrective actions were started but then often later unwound by the ownership of the company,” he said.

The request to place the company in receivership “really goes to the heart of the problem, which is ownership that interferes and puts financial concerns” ahead of medical quality concerns, Kezirian said.

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The agency’s complaint had an extraordinarily tough, occasionally indignant tone that was in sharp contrast to its reputation for bureaucratic caution and reluctance to criticize the influential HMO industry.

The filing noted that “many of Western’s patients are indigent, not fluent in English, poorly educated and thus more trustful of the dentist’s advice and less likely to complain about poor service than the average dental patient,” the lawsuit states.

“All the while, Western rakes in enormous profits directly attributable to its contemptuous disregard for its patients’ welfare,” the state said.

In a statement filed with court papers, Hossain Dezham, a former dentist at a Western Dental clinic in Sacramento, alleged that Western “had a practice of pressuring its employees to produce a certain amount of dental billings each month.”

The company published a “Club 2000 Report” that ranked Western’s dentists according to their monthly “gross production,” Dezham said. “Western paid bonuses to dentists who generated the most production each month.”