Alert: HIV Dental Clinic to Close
Bay Area Reporter April 28, 2008

Seth Hemmelgarn

A San Francisco dental clinic whose clients include low-income people living with HIV and AIDS will close June 30, in a climate where patients' prospects of finding other means of dental care appears tenuous.

Dr. Richard Fredekind, associate dean for clinical services at the University of the Pacific, said the school's Advanced General Dentistry clinic is closing because Medi-Cal reimbursement rates have not kept up with the rising costs of doing business. Fredekind said in 2007 the clinic, which has been around for about 16 years, saw approximately 2,000 patients. Besides people with HIV and AIDS, he said the clinic also serves patients with developmental disabilities and those with other special needs.

"We're doing as much as we can to get people placed elsewhere," Fredekind said. "It's sad that the closure had to happen. We know it's a tremendous inconvenience for some patients."

It is unclear where patients will be able to receive dental services.

Michael Petrelis, a longtime AIDS activist and a patient at the clinic since 1998, said he has "nothing but high praise" for the clinic's staff. Petrelis said he has complex HIV-related oral issues and he worries that other dentists will have long waiting lists, or won't accept Denti-Cal, which is dental coverage offered by Medi-Cal. Governor Arnold Schwarzenegger has proposed eliminating the coverage.

Petrelis said with all the paperwork and low reimbursements associated with Denti-Cal, dentists "don't want to see patients like me."

He also said patients have been left to scramble for continuing care.

Fredekind said that the university began notifying patients in March about the clinic closing. Petrelis said he didn't get a letter until the first weekend in April.

One patient who e-mailed Petrelis after learning of the closing on Petrelis's blog wrote that he hadn't known about the clinic closing even though he had a recent appointment there. The patient asked that his name not be used.

Bill Blum, assistant director of HIV health services for the San Francisco Department of Public Health, said the department shares patients' concerns about ongoing care.

"We want to make sure that people living with HIV with dental needs get the care that they need" and that the city is able to provide funding, he said.

Fredekind and Blum said the university and the AIDS Office are in the process of discussing UOP's contract for Ryan White HIV/AIDS Treatment Modernization Act (formerly the Ryan White CARE Act) funding, which is used to reimburse the school for services provided. They said the funding has remained flat for the past few years.

According to Jim Soos, assistant director of policy and planning for the health department, for the contract year March 1, 2008 through February 28, 2009, the department is providing $496,008 to the university.

About 19 percent of that money is used for services provided by the AGD clinic, according to Fredekind. He said the Ryan White money the university receives is "not even close" to covering expenses.

Care uncertain

Despite the AGD clinic listing several alternatives on its Web site, providers contacted by the Bay Area Reporter mostly said that new clients were not being accepted.

One place the clinic's Web site refers patients to is the San Francisco Dental Society.

Deborah Elam, the society's executive director, said, "Cuts to Denti-Cal and reductions in reimbursement rates makes it difficult for private practitioners to provide services ... It's a challenge right now in this current economic climate for everyone."

Dr. Irene Hilton, the society's president, said, "A lot of dentists take Medi-Cal but don't want anyone to know."

Hilton said many clinics are likely making cuts anticipating that Schwarzenegger's proposal to cut Denti-Cal will become a reality.

She said that for the last three weeks the society's been getting a call a day from AGD patients, and the society will try to work with the university to help them.

Blum said his department is "still in the process of getting clarity about what changes this will mean" and he noted that UOP has a number of other clinics.

He said the department is discussing with the university how it's planning to continue services and "what changes, if any, there will be," and what this means in terms of the university's ability to provide the same level of care.

When asked if this meant the services provided by the AGD clinic could still be available through another clinic at the university, Fredekind responded in an e-mail: "Yes, this is possible. We are working with the Department of Public Health on this."

The AGD clinic's Web site refers Ryan White patients to the Native American Health Center, which provides dental services. But Mark Espinosa, the center's executive director, said this week that the clinic is booked until July and new patients are not being accepted now.

Others outside of UOP suggested the University of California, San Francisco.

But Dr. Anthony Pogrel, a professor and chairman of UCSF's department of oral and maxillofacial surgery, said the school's General Practice Residency clinic already has a six-month waiting list and that they're not accepting new patients.

"Now that AGD is closing, my understanding is that we are the only clinic left in Northern California who will see these patients," Pogrel said, referring to the complexity of the problems AGD's patients tend to have and their reliance on Denti-Cal.

According to AGD's Web site, the UOP's main dental clinic will continue to treat socio-economically disadvantaged patients. However, patients who were transferred from the main clinic to the AGD clinic won't be able to transfer back to the main clinic because of their complex care needs.

For more information, visit http://dental.pacific.edu/PatientService/AEGD-SpecNeed-StocktonClinic/AEGD.htm