Dentist Has Problem Filling Care Gap for Retarded Patients

In four decades as a dentist, Dr. Albert Anderson has carved out something of a singular practice in San Diego. About three-quarters of his patients are retarded.

Indeed, Anderson handles a sizable percentage of the retarded Medi-Cal patients in the area, spending countless hours for a meager monetary return from the state.

The spiritual rewards have been great for the longtime dentist, who holds the prestigious post of vice chairman of the president’s Committee on Mental Retardation. Nonetheless, Anderson finds himself in something of a predicament these days.

As the incoming president of the Zoological Society, Anderson’s time for his dental practice will be severely squeezed after he takes the reins Jan. 1. Moreover, the dentist is now 65 years old. Given his druthers, he’d hang up his high-speed drill and ease into retirement.

Little Interest Shown

But Anderson has been unable to find a dentist to take over his practice. In addition, few dentists have expressed a willingness to treat even a small part of the 1,500 to 2,000 retarded patients Anderson sees each year.

“It’s a very difficult situation,” Anderson said Friday. “I’ve been trying to get someone to come in and help me with my special people. Some have expressed interest, but they back off as soon as they hear Medi-Cal is involved. It’s really a tragedy. I can’t just keep practicing forever.”

Anderson, however, is reluctant to blame the San Diego dental community. Work on Medi-Cal patients is a fiscally precarious undertaking, he notes, with fee reimbursements generally running at about one-third the normal return for dental treatments ranging from fillings to crowns.

Indeed, only about 2% of the dentists statewide are willing to take on retarded patients on Medi-Cal, according to Anderson.

“The fee schedule is so bad, you can hardly blame some of these young guys for refusing to go into that kind of practice,” said Anderson, noting that he has had to subsidize his practice by selling land in the family and drawing from savings.

Medi-Cal gripes abound. A stainless steel crown, for example, might normally cost a patient $125. But the same work fetches a dentist only $18.50 through Medi-Cal, according to Anderson. Moreover, many retarded are forced into the Medi-Cal program since private insurers refuse to cover them because of a higher incidence of illness, he said.

Dr. Graham Simpson, a San Diego Medical Society board member, agreed there is “a big void developing because of the cost factor” in treatment of Medi-Cal patients.

“It’s difficult to make a profit and at the same time do good dentistry under the Medi-Cal payment system,” Simpson said. “You have to do it as a loss leader. . . . Unfortunately, it’s a few individuals who carry that load. Not everyone has the philosophy that this is a community service.”

Also, the paper work and special rules required for Medi-Cal patients can create bureaucratic headaches at a dental office, Simpson said. To be truly efficient, an office practically has to be geared to handling Medi-Cal patients exclusively, he said.

“I don’t blame the Medi-Cal system,” Simpson said. “It’s designed to catch those who are attempting to profit through fraud. But it also makes it difficult for the guy who is honest and trying to do his job.”

There are, of course, other reasons why dentists choose not to treat retarded patients, Anderson said.

Some are downright frightened by the prospect of dealing with the retarded. Anderson often has to perform his work at local hospitals, where the patient can be put to sleep for time-consuming or complex dental work.

Likewise, dentists sometimes fear that the retarded might cause difficulties while mixing with unsympathetic patients in the waiting room, Anderson said.

“They feel they’ll bother their normal patients, but I’ve never had that problem,” Anderson said. “I’ve never had to set up a special time for my retarded patients. They come in with everyone else. In fact, that’s an important part of getting them back into the community.”

Anderson said he is now talking with two dentists about taking over his practice, but the future for his retarded patients remains unclear. Nonetheless, the dentist vows he won’t leave the retarded “out in the cold. I’ve got to keep helping them.”

“What I’d ideally like to do is quit, and just do my stuff with the zoo,” Anderson said, noting that his responsibilities as Zoological Society president will consume 30 hours a week. “But I don’t see any way of doing that right now. I think what I’ll try to do is just slow down.”

He still hopes to get someone in the office to help at least ease the load. A dentist willing to take on his whole practice, including the retarded Medi-Cal patients, would be akin to “the second coming,” Anderson said.

During the coming months, the dentist plans to use his clout on the presidential committee and as past president of the American Academy of Pediatric Dentistry and other national dental organizations to push for more money in Medi-Cal programs.

He also has talked with officials at Mercy Hospital about setting up a special dentistry clinic for the retarded, but the idea has foundered so far because of the Medi-Cal issue.

In the meantime, Anderson continues to care for the retarded, filling teeth and examining gums, just as he has since 1947.

“It’s something I like,” Anderson said. “I just enjoy taking care of them.”