Queens dentalTHE QUEEN'S MEDICAL CENTER's dental clinic, which treated nearly 4,000 poor and seriously ill people in the past fiscal year, is scheduled to close June 30.
clinic closure frustrates
Shutting down the program
could force emergency
operations to the mainland
By Helen Altonn
State health officials and concerned dentists stress that the 40-year-old clinic is the only facility of its kind in Hawaii and its closure will leave thousands of people without dental services.
"It is the only program in the state that can provide services to those who require anesthesia," said state Health Director Bruce Anderson. He said the clinic last year had 3,900 patient visits, of which 293 required acute hospital care.
The estimated cost of transporting one person to the mainland for urgent dental care or "same-day treatment" is estimated conservatively at $25,000, Anderson said. Last year, the clinic had 30 such cases -- a cost of more than $750,000 if sent out of state, he said.
Dan Jessop, Queen's executive vice president and chief operating officer, said the clinic is being closed because of "continuing financial losses and the inability to secure state or private long-term funding for at least three years to support the program and provide job security for the dental staff."
He said the hospital has been downsizing and closing programs to cope with its operating losses -- nearly $8 million the past fiscal year -- and it will continue to review departments with budget losses.
Dentists who volunteer at the clinic said they could have obtained a three-year federal grant but the hospital administration would not make a commitment to maintain the clinic for three years.
"With the constraints Queen's has put on us, we have not been able to find funding," said Dr. Angela Chin, graduate of the residency program who has a private practice in Aiea and heads Queen's Dental Division.
She said the clinic cut a $350,000 operating loss to $200,000 this fiscal year and the dentists developed a business plan to achieve greater savings and efficiency. They did everything Queen's requested, she said, "but we're stuck in a box that Queen's has set up for us. Where can we go now?"
JESSOP TOLD a group of the dentists Tuesday that the hospital was planning to close the operation to cut costs and use the space more profitably. But he said he would again take their plea to save it back to the hospital's budget and finance committee.
He told the Star-Bulletin then that the decision was not final but, "We have to face reality. If there is no reimbursement and we continue to lose money on the (dental) program, we have to make a hard decision."
It had to be done quickly, he said, before making commitments to dental residents for the fiscal year starting in July.
Friday's decision left hopeful dentists who have worked over the years without pay at the clinic distressed and frustrated.
"This is a very poor decision, poor for the community and poor for the whole state," Chin said.
Queen's had planned to close the clinic last June because of continual operating losses resulting from low reimbursements and free care. Its life was extended for one year with a $400,000 state subsidy after first lady Vicky Cayetano talked to the parties involved.
LEARNING OF THE LATEST decision to close the clinic, Cayetano said, "It's a good program and serves the community well. I wish both the state and Queen's would do everything possible to ensure that it continues."
The dentists' committee working to cut costs at the clinic said its operating loss is "a very manini part" of the hospital budget at 0.25 percent.
"We were hoping to find some funds to tide us over until the Legislature could work it into the budget, if they ever would," said Dr. Bill Scheerer. "However, it doesn't seem that there's enough community interest, and not enough interest in the hospital itself, to put up with a deficit for a few years."
It is far less expensive to subsidize the clinic with $200,000 than to pay transportation costs to send patients to the mainland for hospital dental treatment, Anderson said.
He said health officials have been working with Queen's for six months to develop options but Jessop made it clear the clinic cannot continue past June without guaranteed funding.
Anderson informed Sam Callejo, the governor's chief of staff, about the situation and Callejo said he would look into it, then talk to Gov. Ben Cayetano.
Dr. Mark Greer, a graduate of the residency program and now chief of the state Dental Health Division said closing the clinic will create "a significant void, and we'll have to strategize on how to get these services to people."
THE CLINIC, or General Practice Dentistry Residency Program, has agreements for dental care with the Life Foundation, Salvation Army Drug Treatment Center, Family Treatment Center at Kekela, and Oahu prisons.
Forty-four dentists donated time to the program the past year. Greer estimates that their day-time hours were valued at more than $182,000. Many also provided free after-hours care.
Chin said many patients are mentally ill, medically fragile and disabled.
The clinic's two residents -- the only dentists in Hawaii on call 24 hours a day -- are swamped with emergencies and same-day surgery.
The proposed business plan called for a third resident so the clinic can be more productive and for the clinic to do its own billings instead of the hospital, she said.
Dr. Richard Courson, among volunteer dentists, said, "I think we were doing a good job and on the right track. I think with additional time we could get the deficit down further and turn the clinic around so we would be profit-making, but it would take another couple years."
Many Hawaii dentists have been trained in the Queen's clinic, which has the state's only dental residency program. If the program closes, no one will be trained to do hospital dentistry so people with dental emergencies will have nowhere to go, Courson said.
"The big question is what happens to these people?" said Scheerer, who has volunteered at the clinic almost weekly since 1961. "Somebody's going to have to provide for them some way."