Bulletin E-Edition:
more photosDr. Spencer Krueger talks with patient Robin Weeks, 38, as her son Jeremiah Weeks, 10, watches from the driver’s seat of the Mobile Dental Van. The van was at the Volunteers in Medicine Clinic in Bend on Thursday.
Rob Kerr / The Bulletin
Little success in filling dental van’s budget gap
Lack of funding (and enough volunteer dentists) is leaving the area’s uninsured without adequate care. “For (these) adults,” says one volunteer, “there’s really nothing else.”
By Patrick Cliff / The Bulletin
Published: July 13. 2009 4:00AM PSTWhen Debbie Stumbaugh talks about a decision she made in March, her cheery demeanor fades and she begins to cry.
Stumbaugh manages the Mobile Dental Van, which provides free dental care throughout Central Oregon and has recently faced budget problems. Looking for a solution, Stumbaugh decided she had to make fewer visits to some of the sites whose clients were in the most desperate need. Though some can’t, the van asks sites to pay a fee, though individual care is free. Those organizations — including the homeless shelters Bethlehem Inn and The Shepherd’s House in Bend — were running on tight budgets and couldn’t afford to pay the fee of up to $600.
Stumbaugh would still visit those sites, but only once every four months.
Stumbaugh holds dental clinics at about 40 sites dotted across hundreds of miles from Christmas Valley to Bend to beyond John Day. Some of the sites pay a fee; others historically can’t.
When funding was strong, that wasn’t a problem. In the recession, though, the van is struggling, and Stumbaugh has been less able to help those who need it most, she said.
“These poor guys down there at the Bethlehem Inn and Shepherd’s House, they’re not getting any care at all, and their situation is getting worse,” Stumbaugh said. “By the time I get back to them, they’re beyond help. I just hate it because these are people who are trying to integrate themselves back into society, and here they are with no teeth.”
Before its funding problems, the van was already overwhelmed. Then in the past year, patient referrals have increased by about 50 percent, according to Stumbaugh. She finds her patients through partner referrals.
Compared with the van’s other partners, St. Charles Bend refers more patients — up to 200 each month, Stumbaugh said. But in a good month, the van sees only 160 people. In other words, St. Charles Bend alone refers more patients in a month than the van can handle.
The van, actually an RV, looks like a vacationer’s dream. But viewed from the inside, there is no mistaking what purpose the van serves. Behind the driver’s seat, where a couch or dining table might normally be, is one of two dentist chairs.
As classic rock played over the van’s radio, Stumbaugh moved quickly, checking the patient list, assisting on a procedure or helping calm a patient nervous because it’s been years since a visit to the dentist.
Each van costs about $100,000 to operate annually, according to Steve Vickers, director of the mobile dental van program at Medical Teams International. The nonprofit runs Stumbaugh’s van and 10 others across Oregon and Washington. On average, a van cares for 1,600 patients annually, donated care that is worth about $650,000, Vickers said.
Among the organization’s vans, Stumbaugh has one of the most rural routes, Vickers said. Not only does she visit sites in the region’s cities, but she also travels to Christmas Valley and east of John Day. An average drive between sites in Portland is 20 minutes, but Stumbaugh often drives three or four hours for a clinic, Vickers said.
Dr. William Guy, a Bend dentist who has volunteered in the van, said Stumbaugh’s work is critical to the region’s health. Without her, people who don’t have dental insurance likely would not get care.
“She is the van. She’s a godsend,” Guy said.
A long line
Another challenge of operating the van in a rural area is the relative scarcity of dentists to volunteer, Vickers said. Each month, Stumbaugh averages about a dozen clinics. But some months she’s been able to run as many as 22 clinics, Stumbaugh said. The number of clinics Stumbaugh holds depends almost entirely on the amount of volunteer hours she gets from local dentists.
“That’s the big one — getting those doctors,” Stumbaugh said.
On Thursday, Stumbaugh had the van at Volunteers in Medicine in Bend.
During a six-hour span, Stumbaugh and the volunteer dentist might be able to see 16 patients, depending on the procedures each patient requires. They only work on those patients whose problems can be fixed with fillings or tooth extraction. If someone needs a crown, for example, Stumbaugh refers the patient to a dentist, some of whom offer her patients discounts.
Even with that narrow scope, waiting lists grow. At the Volunteers in Medicine Clinic, many patients have to wait six to eight months to get into the dental clinic, according to Becky Kierulff, one of its volunteers. Patients with more pain sometimes get seen faster.
But for adults with no dental insurance, not many other options exist, Kierulff said.
“We don’t even have any dentists we can refer them to,” Kierulff said. “For adults, there’s really nothing else.”
There isn’t enough low-cost or free dental care in the region to handle the problem, according to Stumbaugh and others. People with tooth pain visit St. Charles Bend’s emergency room more frequently than anywhere else, Stumbaugh said. Doctors there can prescribe antibiotics to treat a dental infection, but they can’t do much else, Stumbaugh said.
The antibiotic treats an infection, but it doesn’t help the root cause of the infection. Patients end up returning to the ER again and again for the same problem.
“Someone walks into the ER, has an abscessed tooth,” Guy, the dentist, said. “Those physicians don’t have the instruments or the skill set to take it out. They send them on their way to the tune of $400. St. Charles absorbs it. Six weeks later, history repeats itself.”
Looking for help
Some free or low-cost options for children operate in Central Oregon, including the Tooth Taxi, which visits from the Willamette Valley. But the van is the primary option for free adult dental care in the region, Stumbaugh and others say.
To address the care shortage, several dentists are working with St. Charles to install some dental care in the hospital’s emergency room, according to the hospital’s Emergency Department Manager Darin Durham.
“Obviously, the dental van is overwhelmed. Patients have no other options,” Durham said. “We’re trying ... to set something up here on a volunteer basis.”
Durham said no timeline has been set for when emergency dental care could be available at the hospital, but acknowledged that an emergency dental clinic a few hours each week at the hospital wouldn’t solve the problem.
Dr. Keith Krueger, of Bend, is an oral and maxillofacial surgeon who volunteers in the van. Krueger said the region could use a full-time dental clinic for people without insurance. Though many dentists offer pro bono care, they often do that only for current patients who have fallen on hard times, Krueger said.
“There really isn’t any defined system,” Krueger said.
People commonly let their teeth decay until pain becomes too great, Stumbaugh said. At that point, it’s often too late for the dental van to help much.
The consequences of waiting for treatment can be severe and long-standing, Stumbaugh said.
Stumbaugh, for example, has met several people who were missing several teeth. One woman didn’t have a job but had gone on several interviews. All of them went well, to a point.
“They can’t get jobs because they don’t have front teeth,” Stumbaugh said. “She said, ‘I get to the interview, and everything is going really good. Then I smile, and it’s over.’”
Dental health, though, also can affect a person’s wider health, Stumbaugh said.
Stumbaugh recently saw a patient at Volunteers in Medicine who was in line to receive a kidney transplant. Without the transplant, the patient would eventually die. But she couldn’t get the transplant until all of her teeth were in good health. The transplant couldn’t go forward with the risk of dental infections, Stumbaugh said.
More common is someone like Robin Weeks, 38, of Bend, who visited the van Thursday. Her family doesn’t have dental insurance, which hadn’t been a problem until Weeks felt a pain in her tooth.
As she waited in the chair, Weeks said she was nervous. As it turned out, her tooth was too far gone for the van to help. Weeks found out she needed a root canal and crown, something that could cost about $1,600.
Weeks said the pain had faded recently, and she’d try to wait it out. She couldn’t afford the procedures.
“You know, it’s just a part of life. Sometimes you have (insurance), and sometimes you don’t,” Weeks said as she looked to her 10-year-old son, Jeremiah. “For now, I’ll just deal with it. There are too many other things that take priority.”
Patrick Cliff can be reached at 541-633-2161 or at pcliff@bendbulletin.com.
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