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Queen’s to close
dental clinic in June

The hospital says it can
no longer afford to treat poor
and severely ill patients

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By Tim Ruel
Star-Bulletin

After 40 years of providing critical dental services to poor and severely ill patients, the Queen's Medical Center will shut its dental clinic because the hospital cannot find funding to save it.

The closing of the clinic, scheduled for June, is troubling for all of Hawaii and is a serious issue of public health, state officials say.

No other program exists in the state to provide dental services to those with major existing illnesses -- such as heart problems or cancer -- or to handle tough cases that should be treated in a hospital, including infections, oral trauma and surgery, they say. Also, once the clinic is gone, the islands will no longer have a residency program to train dentists in critical care.

"I'm not very happy," said Dan Jessop, executive vice president and chief operating officer for Queen's. "It's a great community service and it's unfortunately not being reimbursed."

"Nobody likes to make these type of decisions," he said. But faced with financial hard times, Queen's has started focusing its efforts on treatments that are in high demand, such as same-day surgery and emergency-room services.

"Like any business, this is a reallocation of assets, basically," Jessop said, noting that other programs are under similar scrutiny by the medical center.

Bruce Anderson, director of the Department of Health, said the state is worried about the clinic's closing.

"We've got a problem now with those individuals who have special needs -- who require hospitalized dentistry. Frankly, there are no easy alternatives," Anderson said.

The clinic, located underneath the old emergency room at Queen's, is so far-reaching that it even provides critical dental work to some of Hawaii's prison inmates, Jessop said.

Making matters worse, Queen's clinic is the only hospital-based dental residency program in Hawaii.

"Without that program, we don't have the training and incentive for physicians and others to learn the latest techniques, and eventually, that will erode the quality of care that's here," Anderson said.

Jessop said the clinic is staying open until late June to let the two current residents finish their year of training. Queen's said it will try to find other positions for the clinic's six other employees but if it cannot, they will be laid off.

The planned shutdown is the latest example of cost cutting at the state's largest hospital. In the face of diminishing federal reimbursement for Medicare and Medicaid patients, Queen's has cut about 460 jobs over the past four years. It also dropped its cardiac rehabilitation unit earlier this year.

With the Balanced Budget Act of 1997, Congress is slashing an estimated $250 billion in Medicare and Medicaid reimbursements to hospitals nationwide through 2002. Queen's, which had kept its budget in the black for much of the 1990s, began posting multimillion-dollar losses the year after the law took effect, culminating in a $10 million operating deficit for the fiscal year that ended in June.

Queen's hopes to break even by June 2001, but still faces a $9.3 million cut in reimbursements this year alone, the hospital said.

In April, Jessop warned the board of directors at Queen's that the dental clinic, which handles about 4,000 patient visits annually with a staff of eight, was losing $350,000 a year -- mainly from providing free care to the poor without compensation.

Not wanting to post another loss this year, but also not wanting to close the clinic, the board let the hospital look elsewhere for funding. Queen's approached Mark Greer, Hawaii's chief dental officer, and Virginia Pressler, a deputy director of the state Health Department.

Greer, who had done his dental residency at the clinic at Queen's in 1983, said he desperately wanted to help. "Queen's set the stage for my whole career," he said.

The two officials searched fruitlessly for funding from the federal government, Greer said.

Meanwhile, the Health Department said it could not pay because the agency is dealing with its own budget cuts. And Greer said he did not know of any private sources that could contribute.

Jessop returned to the board last month and it approved the closure.

Some options will remain for patients in the wake of the closing, though not many, Greer said. The state runs four dental clinics that serve the poor and Hawaii's community centers contribute another three. Also, plastic surgeons and other specialists can handle severe cases of dental fractures -- for those who can afford it.

People with severe mental or physical illness can seek out dentists who have gone through the residency at Queen's. However, only six or seven qualified dentists in the state regularly handle that kind of work, Greer said.

"There aren't enough people in the community that are trained and willing to provide hospital dentistry services," he said. "When it's not there, everybody is going to be aware that it's not there, because there's no other place to go."