Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, November 13, 1995 TAG: 9511130066
SECTION: VIRGINIA PAGE: C-1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
DATELINE: LENGTH: Long
The situation is equally tough for another needy group.
Each Thursday, about half of the low-income employed people who queue up for dental care at the Bradley Free Clinic in Roanoke are turned away. Last week was a good week; 16 of the 28 in line got help.
For its first 16 years, the private clinic saw any working adults who showed up no matter where they lived, but the dentists became overwhelmed.
"People were coming from three hours away," said Estelle Nichols, the clinic's executive director.
Three years ago, the clinic began seeing only people from the Fifth Planning District. Residents of Bedford and Franklin still show up, Nichols said, but don't get helped.
Even with the geographic restrictions, the clinic had more patients than it could handle, partly because the Roanoke Health Department's dentist stopped seeing adults about a year and a half ago. That dentist has since left, and the city health department program has been suspended altogether.
Lack of access to dentists for poor adults and their families has reached a critical level in the area, and the solution won't come easily, health care workers say.
"This is an incredible crisis," Nichols said.
Roanoke social worker Barbara McCormick, whom Rashaad's mother called for help, agrees.
"I get a tremendous number of calls from people who have Medicaid and can't find a dentist," she said.
Another problem, McCormick noted, is that dental care coverage for the indigent stops at age 21, stranding young pregnant women who often have problems with their teeth.
Those women have nowhere to go.
The free clinic's mission is to the "working poor," people with minimum income and no insurance, Nichols said. It doesn't see unemployed adults or children with Medicaid coverage, like Rashaad.
Medicaid recipients are presumed to have the same access to health care as anyone with private insurance or the means to pay.
But they don't, Rashaad's mother learned when her 8-year-old pulled a loose baby tooth by hand and left behind what appeared to be a piece of tooth.
"His gum got red and sore, and I had no choice but to call a dentist," Green said.
Green first appealed to McCormick, but the social worker didn't have a recommendation. Next, Green called the state Medicaid office, and eventually got a list of dentists who supposedly accepted Medicaid patients.
But when she started calling for an appointment, she got answers like "used to," "can't take any new patients" and "was never on the list." The newspaper got the same answers when it surveyed the dentists.
Green said Medicaid workers even told her to try dentists in the New River Valley and Medicaid would pay the taxi fare at $8 per mile.
Green, who is in a job training program and works part time at Phar-Mor, said she refused to spend that kind of money for transportation, even if it wasn't her money. She kept calling local doctors and eventually got Rashaad in to see one in Southwest Roanoke. She lives in Southeast.
Rashaad didn't have a broken tooth, but he does need dental work, the doctor said.
When contacted, the dentist said he didn't want his name in the newspaper for fear that he would get more patients than he could handle. Taking Medicaid patients is part of his "charity work," he said.
Accepting Medicaid patients is too much trouble, said nine of the 18 dentists who responded to a recent survey on dental care accessibility.
Medicaid reimbursement is too low and the paperwork is too high, they said. Also, many Medicaid patients are lax about arriving on time or keeping appointments at all, they said.
Five dentists said they would be more willing to accept Medicaid patients if the patients were referred through an established agency that would provide transportation.
The nine dentists who said they accept Medicaid patients average 26.3 each. Some of them also said reimbursement is insufficient.
The state is aware of the shortage of dentists, said Anne Hoge, site coordinator for the Community Based Health-Care Project and Coalition, which did the survey. It was funded by a grant from the Kellogg Foundation and is one of seven studies on community health being done in the country as a joint venture of the American Nurses Association and the National Consumers League.
Hoge said a Medicaid representative told the coalition of health care providers, consumers and business people that the state hopes to increase payments and reduce paperwork.
"But I think it would be next year before it takes place," she said.
Dentists shouldn't be expected to solve the problem anyway, Hoge said.
"The community needs to band together. We need to get the city leaders involved," she said.
In addition to the small sampling of dentists, the coalition distributed surveys to 8,638 schoolchildren and got 6,539 back. Respondents asked for more affordable dental care and more Medicaid providers.
The survey found 1,639 children who had never seen a dentist. A third of them said they hadn't needed a dentist, but another third said they hadn't gone because it was "too expensive." The remainder said they couldn't find a dentist who accepted Medicaid, or they didn't have transportation and there was no dentist in their area.
Other suggestions for improving dental care access were extended hours at dental offices and installment payment plans.
Hoge said the survey was just a beginning. She expects an action plan to come out of a Dec. 4 roundtable discussion by health care providers.
Bradley Free Clinic leaders also are trying to meet more of the demand for dental care by adding a second dental clinic each week. Nichols is meeting Thursday with members of the Roanoke Valley Dental Society to brainstorm ways to do that.
Forty-one dentists volunteer, but many more will have to be persuaded to if services are increased, said Dr. Sandra Andrew, dental society president. She has been a volunteer at the clinic since 1983, but is on a break from it currently.
Time is the greatest barrier to getting volunteers, she said.
"It makes for a very long day if you are going to be seeing your own patients all day and then work all evening," she said.
Also, she knows that some area dentists are reluctant to help because they think the clinic still has old equipment. The clinic's dental facilities were updated last year, though, and "they are as nice as my office," Andrew said.
The clinic is planning an open house for dentists to show off the equipment, she said.
Additional clinic hours won't help the Medicaid patients, though, and Andrew said she does not know how to get more dentists in that program.
She has never accepted Medicaid patients, but she does do charity work, she said. She sees patients from agencies involved in rehabilitative services and helps welfare clients who need dental work before they can go on job interviews.
A third source for low-cost or no-cost dental services, the city health department, also hopes to again offer help to adults, but Dr. Molly Rutledge, health director, said she doesn't know when and to what extent.
Dental care is not a state-mandated service and a decreased budget has forced the health department to first make certain it is providing the services it is required to give by law, Rutledge explained.
Education is also part of the solution to achieving better dental care, said one Roanoke dentist who didn't want to be identified.
People need to understand the importance of caring for their teeth and gums so they can make dental care a priority in their budgets, he said.
"Some patients could afford to see a dentist. They have discretionary money, but choose not to spend it that way," the dentist said.
by CNB