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Dr. Stuart Martin of Richmond (left) and VCU dental student Matt Chapman (right) talk to Kenny Van Deusen
Chapman shows Van Deusen the problems with his teeth. Van Deusen has no dental-care insurance.
Richard Barnette, 50, was among the thousands of people treated at the free dental clinic in Wise County.
Dr. Matthew Storm, a Spotsylvania dentist, was one of the volunteers at the 2007 free dental clinic in Southwest Virginia. The huge turnout at the annual event illustrates the need for better dental care for low-income people. |
BY FRANK DELANO
Kenneth C. Van Deusen is a 32-year-old Westmoreland County laborer with bad teeth. He lives with his mother, sister and nephew near Montross.
Van Deusen is also poor. He takes work when he can find it. He reckons he earned $2,000 doing odd jobs last year. He lacks medical and dental insurance.
In September, a toothache sent Van Deusen to the Northern Neck Free Health Clinic in Kilmarnock.
It was the first 50 miles of a medical ordeal that cost nearly $44,000. He received rapid, lifesaving care, but most of its cost will be paid by everybody in one complex way or another.
His journey also illustrates the plight of the poor in obtaining dental care. Health care reforms now being debated in Washington appear to offer little hope for better dental care for the millions of people like Van Deusen.
At the Kilmarnock clinic, Van Deusen paid $25 to see a dentist, who outlined a plan for 10 of his teeth, including extractions and root canals. He said the dentist told him each tooth would require two or three visits at a cost of $25 per visit.
"It ain't a lot, but it is a whole lot when you ain't got nothing," Van Deusen said. "It just started adding up to the point that I couldn't afford it."
The clinic asked him to pay $25 in advance for a second dental appointment in October. "I didn't have it, so I didn't make the appointment," he said.
Van Deusen's toothache worsened. He woke up Sept. 27 with painful swelling in his jaw and neck. The swelling in his throat made it hard for him to breathe. His sister drove him to the emergency room at Riverside Tappahannock Hospital.
"As soon as the doctor saw me, he said that he'd have to send me to Richmond. He called an ambulance, but found out it would take the ambulance an hour to get to the hospital and another hour to get to Richmond. He said I was so bad off that he called the helicopter," Van Deusen said.
The ambulance that took him a quarter-mile to Riverside's helipad cost $457. The 41-mile LifeEvac flight to Richmond cost $16,298.52. The ambulance in Richmond that took him one mile to VCU Medical Center cost another $500.
He was admitted to the intensive-care unit at VCU. In surgery the next morning, doctors extracted three of his teeth and installed a tube to drain the abscess in his throat. He was discharged the next afternoon.
"When I left the hospital, they told me to follow up with my regular dentist, but I don't have one," he said.
The bills soon started to arrive. For his three days of treatment in the Richmond hospital, the bill was $25,012, "plus bills on top of that for other doctors," Van Deusen said.
"It just added up so fast. Now the total is more than $43,000, and the bills are still coming in.
"Nobody told me how much all this was going to cost. Nobody. But I really needed treatment at that point and didn't have a choice. I could have died and been buried four times for that amount of money," he said.
A DESPERATE NEED
Dental ordeals such as Van Deusen's "are situations faced by many adults in Virginia every day. Some of them are so desperate and in so much blinding pain that they pull their own teeth," said Deborah D. Oswalt, executive director of the Virginia Health Care Foundation.
Van Deusen is one of more than 100 million people in the United States without dental insurance. He is also a victim of what the U.S. surgeon general called a "silent epidemic of dental and oral diseases" caused by "profound" disparities in dental care.
"Those who suffer the worst oral health are found among the poor of all ages, with poor children and poor older Americans particularly vulnerable. Members of racial and ethnic minority groups also experience a disproportionate level of oral health problems," the surgeon general wrote in a 2000 report.
Locally, dental-care needs are especially great among the growing Hispanic population, said Dr. Cathie H. Butterworth, a Fredericksburg dentist who organizes an annual free dental clinic called Dentistry with a Heart.
"Patients start lining up at 3 a.m.," she said.
In July, 2,715 people from 16 states showed up at a free weekend medical and dental clinic staffed by 1,800 volunteers in Wise County. Dentists conducted 1,850 exams, pulled 3,857 teeth and filled 1,628 cavities.
The Virginia Dental Association was part of the Wise County clinic. In the past 10 years, the VDA has fielded 41 Missions of Mercy in mostly rural sections of the state. The missions have provided $16.5 million in dental services to 32,000 Virginians seeking relief from the pain and embarrassment of their teeth.
"I call this group 'the silent voices of need,'" said Dr. Terry D. Dickinson, executive director of the VDA. "You won't see them down at the General Assembly asking for adult benefits, as they would lose their jobs if they missed a day to advocate for themselves. This is truly a population that, for the most part, is unseen and unheard."
Regular dental care might have prevented Van Deusen's toothache. But the need to find a dentist, high out-of-pocket fees, and transportation and child-care issues often prevent low-income people from obtaining dental care, according to a 2008 report of the Kaiser Commission on Medicaid and the uninsured.
The Virginia Department of Health provides dental care, most of it for children, in 39 of the state's 134 counties and cities. A safety-net system of 57 community-based dental clinics provided 43,976 visits last year, "but that's just a drop in the bucket considering the hundreds of thousands of people with no dental insurance in Virginia," said the Virginia Health Care Foundation's director.
"There's an unbelievable unmet need," said Oswalt. Some community clinics are open only a night or two a week. Waiting lists can be months long. Oswalt said one clinic recently reported to the VHCF that "pain is not an emergency."
HOLES IN THE NET
It was into this flimsy safety net that Van Deusen jumped when his toothache forced him to seek help at the Northern Neck free clinic in September. It was his first trip to the dentist since he was in grade school, he said.
The clinic's six dental chairs are full four days a week. Two paid dentists, volunteer dentists and dental students see low-income patients like Van Deusen. "We're pretty close to maximum capacity," said Jeannie Nelson, the clinic's director.
She said it costs the clinic about $375,000 a year to provide nearly $2 million in dental services to the poor. In all, the clinic provides $6 million in medical, dental and pharmacy services on a $1.2 million budget that depends on donations and volunteers.
The bad economy has cut donations and increased demand for services. "Some donors are now patients. This year we're facing a $250,000 deficit. It could be the first time in our history that we've been in the red," Nelson said.
She said the $25 fee for dental appointments helps ensure that patients will show up for appointments. The fee can be waived, she said.
Van Deusen said nobody at the clinic told him about the waiver when he was there.
The misunderstanding resulted in Van Deusen's emergency treatment that cost $43,991.88.
The bill was paid by others, through taxes and higher costs for medical care and coverage.
Frank Delano: 804/761-4300
Email: fpdelano@gmail.com
| $571.23
Emergency-room visit at Riverside Hospital, Sept. 27 $636 Riverside ER visit $457 LifeCare ambulance $16,298.52 LifeEvac helicopter $500 Richmond ambulance $344 MCV ER visit $25,012.13 Stay at MCV Hospital, $173 MCV outpatient care $43,991.88 Total |
