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Closure of Tufts dental clinic leaves disabled patients without care

Published: Tuesday, April 6, 2010

Updated: Tuesday, April 6, 2010 07:04

Dentist

MCT

Dental care will no longer be available at the Fernald center following its privatization.

Tufts Dental Facilities' clinic in Waltham will close due to a cost-saving measure by the state, potentially leaving over 2,000 developmentally disabled patients without dental care.

Citing a lack of funding, the state plans to privatize the Fernald Development Center, a residential facility for patients with severe mental disorders, autism or brain injuries.

The center houses a Tufts dental clinic that as of June 30 will be forced to relocate or close.

"This is a huge injustice to the developmentally disabled population," Marilyn Meagher, head of the advocacy group Fernald League for the Retarded, Inc., said.

The Waltham clinic, the largest of its kind in the metropolitan area, provides dental care for developmentally disabled patients and serves as the hub of Tufts Dental Facilities, according to Executive Associate Dean of the School of Dental Medicine Joseph Castellana.

Castellana explained that Tufts Dental Facilities is a collection of seven School of Dental Medicine-operated sites serving disabled patients. It was established under a contract with the Commonwealth of Massachusetts following a 1976 class-action lawsuit that mandated the state provide the same or better care to disabled patients as if they were institutionalized. 

However, with the upcoming closing of the Fernald center, the Waltham clinic must relocate or close.

"At the moment, it is an unresolved problem," Castellana said. "We are trying to find another location, preferably on state-owned property comparable to Fernald in order to provide the same level of care."

Tufts Dental Facilities patients cannot simply switch to a private dental practitioner because they suffer from severe metal defects, autism, cerebral palsy, head trauma, spinal chord injuries or other kinds of psychological disorders.

"These are not patients that can be treated in a conventional dental office," Castellana said.

"Although the actual dental care is very similar to [that of] a normal patient, the challenges are several-fold," Assistant Professor of Public Health and Community Service Darren Drag, who runs Tufts' special-needs dental program, said. "The reason our practice exists is to combat those challenges."

Drag further explained that a lot of the program's patients have behavioral challenges and require anesthesia or oral sedation, treatments that are rarely available in a typical dental office. Many patients are also confined to wheelchairs and require special accommodations such as large doorways and operating rooms. 

In addition, Drag noted that 90 percent of the 9,000 patients Tufts Dental Facilities serves are covered under MassHealth, the state health insurance plan, which many dental providers do not accept.

"The whole mix of health insurance, medical complications, legal issues relating to third parties and financial constraints make it extremely difficult for patients to receive adequate care on their own," Drag said. "Tufts Dental Facilities staff is equipped to work with this population."

Castellana noted, however, that geographic and cost considerations are posing barriers to the Waltham clinic's relocation.

"Virtually all of our patients rely on third parties to transport them to their dental care, either by a contracted transportation party or a legal guardian," Castellana said. "In order to ensure that people get care, we can't have them traveling from one end of the state to the other."

He explained that although it is the state's responsibility to cover the expensive relocation costs, it does not currently have the funds to do so.

Drag noted that the 2010 closing date was agreed on before the recession and that funding for the relocation probably would have been available had the economy remained stable.

Tufts Dental Facilities could transfer patients from the Waltham clinic to other locations around the state, but, according to Drag, the most optimistic estimates suggest that other locations can only absorb 29 percent of those patients.

Meagher questioned the logic behind privatizing the Fernald Development Center, claiming that its new incarnation would become more expensive to maintain.

"I don't think this is a reasonable measure," Meagher said. "Closing the center would not be economical for the state because private vendors are more expensive to the taxpayer."

According to Meagher, since the planned closure of the center, there has been a reduction in the quality of care. 

"The situation is getting very poor," Meagher said. "Services are getting cut and will continue to get cut, and residents are being put in jeopardy."

Castellana noted the sense of duty that he feels Tufts has to serve the disabled population.

"These are patients who cannot self-advocate and can't walk into a private dental office," Castellana said. "The burden is on all of us to serve this population.  The state is required by a lawsuit to address this issue, but Tufts' dental school is obligated to serve this population because community service is inherent in our mission."

Every effort is being made to find a solution to the problem, according to Castellana.

"Tufts dental school is working every day to determine another location where we can provide services to patients who can't be absorbed and to work with [the] state and Department of Health to get funding and begin operation," Castellana said.

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