Dental care for disabled may grow even scarcer

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Dental care for disabled may grow even scarcer

http://www.latimes.com/news/local/politics/cal/la-me-dentist4-

2008jun04,0,2464087.story?page=1 & track=rss

By Engel, Los Angeles Times Staff Writer

Dr. Zschaschel leaned over Boogie's wheelchair to check his

teeth with a mirror and probe.

Boogie wailed.

" It's OK, Boogie, " said his father, Vergery Grubbs Sr. He reached

over to take his son's curled hand. " Keep your mouth open. You're

doing a good job. "

For the elder Grubbs, this was the easy part. The challenge had been

finding a dentist willing to treat his namesake, who is 13 but looks

half that age. Dubbed " Boogie " because music makes him laugh, Vergery

Grubbs Jr. was born with cerebral palsy and hydrocephalus, or water

on the brain. He is mentally and physically disabled.

Once father and son waited for three hours to see a dentist, only to

be told to go to a county hospital.

" I was hopping mad that day, " Grubbs said. The dentist " wanted to put

him to sleep just to clean his teeth. "

Zschaschel hears such stories all the time.

" I'm kind of the last-resort dentist, " she said. " There are very few

private dentists who will take on this kind of work. "

With cuts to the state's Denti-Cal program scheduled to go into

effect in July and another round of cutbacks already on the table,

there could soon be even fewer.

Finding dentists to care for patients with disabilities is a

challenge under the best of circumstances, said Dr. Glassman, co-

director of the Pacific Center for Special Care at the University of

the Pacific School of Dentistry in San Francisco.

For starters, he said, few dental schools teach students how to care

for patients with disabilities. Over the last 12 years, the USC

School of Dentistry has required every student to spend a week

working in its Special Patients Clinic, one of the few clinics

dedicated to patients with disabilities. But most dentists in private

practice haven't had that kind of experience.

Another barrier is the state's low Denti-Cal payments. Disabilities

can interfere with finding work and take a toll on family resources,

so many people with disabilities depend on this state-federal

insurance program for the poor.

But dwindling numbers of dentists accept Denti-Cal patients because

reimbursements are among the lowest in the country. They will fall

even lower under a 10% rate cut scheduled to go into effect July 1 as

part of the Legislature's efforts to reduce the state budget deficit.

And Denti-Cal doesn't pay extra for the additional time that goes

into treating a patient with disabilities.

" You're asking dentists to do something they're not well-trained to

do, that's going to take a lot of time, and they're going to be paid

a third of their normal rate, " Glassman said. " It's no surprise that

a lot of people aren't lining up to do this kind of work. "

Hospitals aren't lining up either.

Depending on the degree of disability, some patients require general

anesthesia at a hospital to have a tooth pulled, a cavity filled or

even just a cleaning.

But across the state, hospitals that once extended staffing

privileges to dentists like Zschaschel are cutting back on dental

services or discontinuing them altogether, Glassman said.

" It's pretty clearly because of money, " he said. " Hospitals have to

pay attention to their bottom line. They have to stay in business. "

Zschaschel used to treat about eight patients a week under general

anesthesia at St. Medical Center near downtown Los Angeles.

She is now down to about four a month, which the hospital evaluates

on a case-by-case basis.

Dr. Jay Rindenau, an anesthesiologist and consultant who advised St.

to cut back its dental services, agreed that California's low

reimbursements strain hospitals. But that was not what drove his

recommendation, he said. Children with disabilities have a higher

risk of complications, he said, and unlike county, teaching and

specialized children's hospitals, St. does not have a

pediatric unit.

" It's absolutely a quality-of-care issue, " he said. " You need to be

doing procedures at places that are well-suited to handle any

complications that occur. "

But the parents and caretakers of Zschaschel's patients say they face

long waits at backlogged county and teaching hospitals. Like Grubbs,

many search for months to find a dentist willing to treat a child who

is paralyzed or autistic or whose diabetes is out of control, which

makes anesthesia riskier.

She is inspired to do so because of the example set by her late

mother, a Cuban immigrant with a strong religious faith. By age 3,

Zschaschel was accompanying her mother to feed the homeless.

After majoring in psychology as a UCLA undergraduate, Zschaschel

worked with autistic children. She remained drawn to patients with

special needs after starting dental school, also at UCLA. Now 39 and

in solo private practice, she sets aside Mondays to care for patients

with disabilities.

She has endured slaps and punches, thrown out her back leaning over

wheelchairs, chased patients down sidewalks and done exams in cars.

But her days are not short of hugs or gratitude. And they're never

boring.

" I enjoy the challenge, " she said. " I like doing what nobody else can

do. "

has been driving his grandson, Reyes, from

Victorville over the last year to have a tooth pulled, a cavity

filled, a cleaning. Reyes, 21, survived leukemia at 15, but a

reaction to the chemotherapy robbed him of motor and mental skills.

" She's great with this guy, " said as he gently lifted his

grandson from the wheelchair to Zschaschel's dental chair.

Diane also drove from Victorville after her son, Victor Hill,

was turned down by five other dentists. He is autistic and had an

abscessed tooth he tried to remove with pliers.

" It's like these children are just in the shadows, "

said. " They'd prefer you put them in homes. "

Hill is 29, and like Reyes, he is not -- technically -- a child,

which presents another dilemma: On top of the payment cuts scheduled

to go into effect July 1, Gov. Arnold Schwarzenegger's revised budget

calls for eliminating Denti-Cal benefits for adults. With clinics and

county hospitals backlogged, that would make it even harder than it

is now for poor adults to find dentists, much less poor adults with

disabilities.

" It's going to come to the point that there's not going to be

anywhere people can go, " Zschaschel said. " We're going to be like in

the 1800s, when people actually died of dental infections. "