We first investigated Western Dental 14 years ago, and the HMO is using the same response now as it did then -- the cases we are highlighting are a small fraction of the 700,000 patients they see each year, and that the complaints are not typical of the quality of care the HMO provides. They also say these stories are "not consistent with the facts."
The I-Team took a look at both sides.
Western dental's commercials drive home the message -- their dental care is affordable: "With easy monthly installments at no interest, even if you have poor credit."
But several patients tell the I-Team they suffered costly mistakes at the hands of Western Dental dentists.
"No feeling [pats cheek], you could probably actually sock me right now and I'm not going to feel that," said former Western Dental patient Unieve Wilson, who went to the Western Dental in Oakland to have her wisdom teeth pulled, but the dentist severed a nerve. The damage is permanent. "Just an embarrassment of drooling unexpectedly, not knowing when it's going to just come down out of my mouth, drool, a real big slur in my speech."
Without admitting fault, Western Dental settled with Wilson in April for $120,000.
"Bottom line, every one of our patients gets great care," Western Dental CEO Sam Gruenbaum said in a television ad.
Gruenbaum refused to be interviewed on camera, but sent a pre-recorded statement from the HMO's dental director.
"Unfortunately, Ms. Wilson experienced these complications," said Louis Amendola, chief dental director for Western Dental. He says Wilson understood the dangers, before the surgery. "She was informed of the risks and benefits and signed a consent form to explain the possibility of nerve complications from removal of the lower wisdom teeth."
"There's nowhere in the consent form where a patient consents to doing it wrong," said Wilson's attorney, Ed Zinman. Zinman, has sued the HMO more than 60 times over the past 15 years on behalf of patients.
"If I'm only one attorney and I've sued them over 60 times, then what I can imagine is just the tip of the iceberg," Zinman said.
Cindy Moe had gone to Western Dental twice for cleanings, gum disease and to have her wisdom teeth pulled. In 2005, she went back to the Fairfield office to take advantage of their special on braces. However, Moe says a dentist told her she needed so much work, she could not get braces and that it would be cheaper to pull all her teeth.
"It was a big shock because I'm thinking pull all of my teeth? But I'm thinking, this is a dentist office, of course they know what they're talking about," she said.
Moe says she could only afford to have the top row pulled and the dentures fit so poorly, she could not bring her lips together. So, she went to another dentist, Dr. Don Missirlian, who looked at her x-rays and concluded her teeth were healthy, before Western Dental pulled them out.
"I was crying very hard because I'm thinking my teeth are not going to come back, so I'm going to be stuck with no teeth for the rest of my life," Moe said.
Western Dental responds that the state dental board looked into the case and concluded it "did not reveal evidence of negligent dental care."
"Her gum disease had progressed to the point where treating, treatment to retain her teeth would have failed in a short time," Amendola said.
Moe sued and, without admitting wrongdoing, Western Dental settled by paying her $85,000.
"When teeth should have been saved and were not saved, then that's the worst of care, that's negligent, that's wrong," Zinman said.
Same complaint from Eric Fernandez. The 40-year-old says he went to the Western Dental office in Fremont last year to get his teeth cleaned for his brother's wedding. He had a history of gum disease, even lost three teeth because of it. Still, Fernandez says he was surprised by what the HMO's periodontist said.
"I had a real aggressive gum disease and that it was his recommendation that I should have a full extraction," Fernandez said.
The periodontist pulled out all his teeth in one sitting, leaving a hole in the roof of Fernandez's mouth. Then, he went to see Missirlian, who sometimes works as a paid consultant to Zinman.
"Food was coming out his nose when he ate, he had to have it surgically repaired," Missirlian said. He concluded from x-rays that most of Fernandez's teeth were healthy after all, and should not have been pulled.
"That upsets me because they're not coming back," Fernandez said.
And Fernandez says the dentures Western Dental gave him did not fit. He has a new set of dentures from Missirlian.
Now he has filed a lawsuit against Western Dental.
In its video response, the HMO does not address Fernandez's complaint about ill-fitting dentures or the hole in the roof of his mouth. Western says its dentist explained the options to Fernandez -- long-term dental treatment and constant home care or pulling out his teeth.
"He chose extractions and dentures after acknowledging both options and the benefits and risks in writing," Amendola said.
"There's no excuse for people to be damaged and harmed over and over again," Missirlian said. "One is too many."
Nursing student Candice Ward is in binding arbitration with Western Dental. During a root canal at the Santa Cruz office, a dentist pushed the syringe through the tooth and the roof of her mouth, squirting bleach into her sinuses. Ward says even after she yelled in pain, the dentist did it a second time.
"And then I was like, 'OK, that hurts,' so she backed away," Ward recalled. "And all of a sudden my face started to swell."
Ward says the dentist could not figure out what was wrong. Her face became bruised; the pain lasted for months. She had to have surgery to remove dead tissue.
"I had to go to my teachers and say, 'I am not being abused, this is what's happening,'" she said. 'I had to tell them the story, 'This is why I look like this.'"
"The complication in her case was diagnosed immediately by our dentist and proper steps were taken immediately to deal with it," Amendola said.
Ward's attorney says Western Dental paid for an oral surgeon early on, but has not paid the rest of her medical bills which include two hospital stays.
After the I-Team reported similar complaints about Western Dental in 1996, the California Department of Corporations accused the HMO of a "consistent disregard for quality of care and patient health" and hit them with a $1.2 million fine.
"This action represents the largest single enforcement action ever taken by the Department of Corporations," said the department's Keith Bishop back on April 25, 1997.
The Department of Corporations set up a new system of frequent inspections, but times have changed. The California Department of Managed Health Care is now in charge of watching Western Dental, but it only inspects the HMO every three years. Staff depend on Western Dental's own records, and the inspections are announced well in advance.
Lynn Randolph, Dept. of Managed Health Care: We might schedule a non-routine survey.
Dan Noyes: Can you give me an idea whether you've performed any non-routine surveys at Western Dental since 2000?
Randolph: We have not.
Noyes: You have not?
The patients we interviewed say the state, and Western Dental, have to do better.
"You know, not to shuffle us through like we're cattle or something, but to really like sit me down and like, 'OK, hello Candice, what can I do for you? Oh, I made a mistake, what can I do to fix it,' you know? I did not get any of that,' Moe said. "I didn't get anything, I just don't want this to ever happen to anybody."
In the survey last year, the state found that Western Dental was not taking complaints by phone and was not advising pregnant women about the importance of oral hygiene. And, the state fined the HMO $40,000 for failing to reimburse credits on patient accounts. Western Dental agreed to pay the fine and fix those problems.
Gruenbaum and his lawyers claim the HMO "has patient satisfaction levels of over 99.9 percent." They write, "Western Dental's quality control policies, practices and procedures... are among the most stringent and extensive in the industry."