The plight of a proposed dental clinic for the under- and uninsured was front and center Wednesday night.
With state funding for the clinic on hold, Central Peninsula Health Centers Inc. sponsored a public meeting at the Kenai Peninsula Borough assembly chambers to outline the clinic's status in becoming reality and to gather community support for the facility that is planned for Kenai.
The purpose for the clinic was spelled out by one of the attendees: "It would be nice to not have to go to Anchorage and miss school," said 11-year-old Natasha Knight of Soldotna. "It would be nice to not have to always go to the nurse's office."
Natasha was just one of the nearly 90 men, women and children who showed up to speak for or against the clinic, or just to find out what all the fuss was about.
The project aims to bring the clinic to Kenai by March, but its progress was hampered when an elaborate funding mechanism was questioned by some of the parties needed to approve the plan.
When a new state-sponsored funding source was found, the project again was stalled when murmurs, then very vocal concern about how the clinic would impact private dentists raised doubts in state officials' minds that there was indeed community support.
As a possible result, the clinic could have to scale down its services, relying only on the annual $300,000 federal grant the clinic would receive to either operate or get into the building. The clinic is eligible for these funds through the Bridges Community Resource Network as one of the more than 1,000 federally qualified community health centers.
If other funding isn't made available, services will have to be prioritized, going first to children and then to emergency adult cases.
Stan Steadman, executive director of CPHC Inc., said the goal is to use money from a state-funded ProShare grant -- about $570,000 -- to pay off the building in full and approximately $132,000 from a Denali Commission grant to pay for equipment.
However, he said he wasn't surprised at the state's reticence when a fervor began to stir over the possibility of the clinic competing with private industry.
"For a new state government to get involved in an issue where there's a potential negative image, it's understandable for them to pause," he said.
But Robert Hemmen, finance officer for the state health funding agency Alaska Primary Care Association Inc., disagreed that the clinic would compete with private practitioners. He argued that the basic dental care the clinic would provide could actually generate clients for the private dentists.
"We (will) do things like pulling teeth," Hemmen said. "When people have their teeth pulled, what do they do? They go to private dentists to have their teeth replaced."
Dr. Dan Pitts of the Soldotna Dental Clinic said he was there to speak on behalf of the private dentists opposed to the clinic. He pointed to failures in the Alaska Medicaid program as factors contributing to his contingent's reluctance to see Medicaid patients, and he said the money being allocated for the clinic could be better used to pay private dentists to serve Medicaid, Denali KidCare, underinsured and uninsured patients.
"We're using money that can go directly to patient care," Pitts said. "I met with the private dentists in the area and we made a pledge. We said we'd see Denali KidCare patients tomorrow if these issues were addressed."
Among the issues of concern Pitts said were reduced Medicaid reimbursements to dentists, a "most favored nation" status that doesn't allow dentists to discount services below their lowest fee and a "hold harmless" clause that frees the state of liability in the event of malpractice suit from a Medicaid patient.
Pitts also said the limited funding could limit the options for those without insurance, whereas by repairing Medicaid to private dentists, patients could make appointments with whomever they chose.
"In a welfare clinic, you get who's there," he said. "I'm a patient advocate. Patients have the right to choose who they want to see."
Others at Wednesday's meeting responded by saying that the focus needed to remain first on the needs of children's dental health, and then on the well-being of the community.
Michael Becker disagreed with Pitts' idea to reallocate funding to make up for Medicaid shortfalls, and said the CPCH Inc. board is doing the right thing.
"If there was funding available to give to dentists to pay for dental care, I think they would have found it," he said. "This money has already been allocated."
Barry Creighton said the dentists should just let go of the issue.
"It doesn't make sense for dentists to hold kids hostage to get what they want," Creighton said.
Peggy Moore, CPHC Inc. board member, disputed Pitts' earlier claim that private dentists are prepared to see Denali KidCare patients immediately if changes were made to Medicaid.
"Dr. Pitts, when you say that every one of these kids will be served tomorrow, how can you say that when it takes months for my dentist to get to me?" Moore asked.
Connie Wirz, director of the Kenaitze Head Start, said 54 of the 57 children her facility serves are on Denali KidCare. She said without a dental clinic she often sends letters home to parents asking about what kind of dental care the children had, and learns that there has been no care. She said the need goes deeper than just the children.
"What incenses me is that we have a solution," Wirz said. "But instead of saying, 'God bless them,' we throw rocks at them.
"There are enough dental needs to go around. We have parents who need service just as badly as their kids. And what about prevention?"
Traci Martinson, the dental coordinator for Bridges Community Resource Network who is helping Steadman with organizing, said when the facility opens the urgency will be fully realized. She said private practitioners and the clinic would cooperate to serve needs according to the patient's circumstances.
"We anticipate that we're going to be totally overwhelmed because there are so many people not being served," Martinson said. "In a community where there are private practitioners and a public facility, it's a two-way referral."
She said those who came to the clinic with dental insurance or who were above the required income limit would be referred to private dentists. Conversely, those private dentists who receive patients meeting the proper qualifications could make referrals to the clinic.
Pitts' partner, Dr. Ron Martinelli, said he shares the concerns about what he called "handicaps" placed on dentists. But he also expressed ideals similar to Martinson's call for cooperation.
"There is a need," Martinelli said. "Basically, this clinic is not going to be able to handle it alone. If they get this clinic going and get the private practitioners involved, it could be successful."
At the end of the forum, Steadman sent around a petition for those attending to sign acknowledging community support of the clinic. He said he was pleased to have 60 names signed to the list.
"Maybe this is something we should have done before," he said.
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