Unfilled Cavity : Dentist and Friend to the Mentally Retarded Is Retiring, but No One Emerges to Take His Patients

The battle with Alex began even before he reached the dentist’s chair. The 22-year-old retarded man, who has Down’s syndrome, took one terrified look at the bright overhead light and turned for the door.

This, however, is no ordinary dentist’s office. With a few gentle words, Dr. Albert Anderson, the gray-haired dentist known as “Doc” to many of his more than 2,500 mentally retarded patients, slowly coaxed Alex into the chair.

“We’re just going to look at your toofers,” Alex’s father said reassuringly, standing close by Anderson’s side. “Open your mouth, Alex.”

Minutes later, a beaming Alex hopped from the chair with a clean bill of health. In 43 years, Anderson has learned certain tricks to compromise for his patients’ paralyzing fear.

He treats the most timid ones at home, rather than force them through the trauma of an actual office visit. Others are examined in the back seat of their cars. Anderson calls it his curbside service.

And not all patients who walk into his office necessarily make it to the dentist’s chair. When their time comes, some will drop onto the waiting room floor and refuse to budge. So Anderson gets on his knees and examines them there.

Anderson’s compassion for the mentally retarded is deeply rooted. Since 1985, the Point Loma native has held the prestigious post of vice chairman of the President’s Committee on Mental Retardation.

And, for the past three years, he has dedicated his practice exclusively to the often troublesome retarded patients most dentists avoid like an extensive root canal. Although others treat retarded patients, dentists say Anderson is the sole private dentist in the county--and possibly the entire state--to treat only retarded patients.

But, at age 67, the statuesque dentist whom patients like Alex have come to rely upon now finds himself in an uncomfortable predicament.

For the past 18 months, Anderson has sought to retire from dentistry and devote more time to pursuits including posts as president of the Zoological Society and state organizational chairman for U.S. Sen. Pete Wilson’s campaign for governor.

But, despite his continued personal pleas and many ads in professional journals, no dentist has stepped forward to assume even a portion of his practice.

In July, however, when his medical insurance expires, Anderson says he will finally walk away from his Hillcrest practice. Still, he worries over the future of his diverse flock of patients, many of whom have become his friends.

Meanwhile, his days are spent trying to juggle patients between almost 50 hours he spends each week at the zoo and the Wilson campaign office.

He reserves one day to examine up to 50 patients in his office for routine dental checkups and work--and spends part of two other days performing more complicated procedures.

“There’s nothing more exciting to me than taking people out of pain, to see them happy,” he said one recent day at Mercy Hospital after receiving a hug from a patient named Lizzy, a 42-year-old woman with Down’s syndrome.

“This woman has an IQ of about 50, but she still knows me. She reaches up and gives me a kiss each time I see her. And how many other dentists can say that? Sometimes, that kiss is worth all the money you could make.”

Anderson, however, is reluctant to blame his peers in the San Diego dental community for not sharing those views. Work on Medi-Cal patients, upon which many of the retarded rely, is a fiscally precarious undertaking, he notes, with fee reimbursements generally running about one-third the normal return for dental treatments running from fillings to crowns.

For example, Medi-Cal reimburses only $180 for a crown most other dentists are paid $500 to insert--and that’s not counting any lab work or office visits, Anderson and other dentists say.

And then there are the dentists who worry that too many retarded patients would scare off regular customers. Take on one or two, they reason, and word might get out that they had become the dentist to see for retarded patients--perhaps the next Albert Anderson.

“Most of the dentists I talk with feel that what I’m doing with the mentally retarded is a wonderful thing,” said Anderson, who spent two early years in his career treating Hopi and Navajo tribesmen on an Arizona Indian reservation.

“They say that it should be done, that it has to be done. They just don’t want to be the one to do it. Some have told me they’re afraid of having retarded patients in their waiting room, of how their regular patients might react.

“But I tell them they’re crazy, that it’s a real practice-builder, that it shows they have a sense of humanity.”

Last year, while receiving an award from the San Diego County Dental Society for his work with the retarded, Anderson seized the opportunity to make a plea to the more than 200 dentists on hand at the annual dinner dance.

“I made it very clear,” he said. “I told them ‘I’m getting old. I need some help. I have all these patients with no place to go.’ But I don’t think they like to hear those things.”

The plea inspired no response--except from a laboratory technician who called to donate free lab work to the cause.

Dorothy Greaves, executive director of the San Diego County Dental Society, explained that the response was not forthcoming because most dentists at the dinner were firmly established in their practices and could not handle any more patients--retarded or otherwise.

But, although there are other dentists in the county who treat the developmentally disabled, Greaves acknowledged, Anderson’s presence will be sorely missed.

“He’s a compassionate dentist with an intense desire to treat these kinds of handicapped people,” she said. “There will be a problem replacing him, no doubt about it.”

Some local dentists who treat the mentally retarded are already feeling the void that will be left by Anderson’s departure.

Terry Hoot, a National City dentist who also treats many mentally retarded patients in addition to his normal customers, says local agencies have tried to assign him more handicapped patients in anticipation of Anderson’s retirement.

“I can’t take them,” he said. “I already have too many. There just aren’t enough dentists out there willing to accept these patients because of the extremely low Medi-Cal reimbursements.”

Hoot said mentally disabled patients are considered high-risk and require more visitation time, paper work and red tape. “That’s what’s so special about Al. He actually treats these people.

“Many dentists just give them lip service--you know, open their mouths for a moment, say that everything is fine and then send in the paper work. And who’s to know the difference?”

Local experts in the field of providing services for the mentally disabled are concerned about losing Anderson. “He’s a rare dentist,” said Rich Farmer, executive director of the Assn. for Retarded Citizens.

“Where other dentists will just extract a tooth of a retarded person rather than go through the hassle of filling it, he’ll make sure they get the best care. It’s a mission with him.”

Added Raymond Peterson, executive director of the San Diego Regional Center, a nonprofit agency that allocates funds and services for the mentally disabled: “Dr. Anderson is a pediatric dentist, but most of his patients are adults.

“They started out as children and have grown up with the same dentist because there was nowhere else to go.”

In fact, most of Anderson’s patients are now adults--and not all of them are as cooperative as Alex or Lizzy.

“A lot of these people are like little kids, they’re scared to death--except that they’re big people,” he said. “If they don’t want something done to them, you’re not going to do it without putting them to sleep.”

Parents of his patients say they can’t appreciate Anderson enough.

“Not only does he look at Kevin’s teeth, but he has valuable information about his heart condition or any other facet of mental retardation,” said Nancy Sonnenburg, whose 19-year-old son has Down’s syndrome.

“I mean not just any dentist could handle the way my child behaves, or should I say misbehaves?”

Anderson’s concerns are not just for his own patients but for what he calls a new generation of developmentally disabled, many of whom will find it nearly impossible to get proper health care.

These days, because of medical breakthroughs, people with Down’s syndrome are living longer and require long-term care. But there are also abused children and those being born to parents with severe drug and alcohol problems.

And then there is the effect of AIDS.

“(Some) health statistics suggests that 90% of children born with the HIV virus will be retarded,” he said. “And one out of every 40 deliveries in New York City today is from a mother with the HIV virus. Something has to be done to provide these children with health care.”

Recently, insurances companies have canceled policies of families with retarded members because of rising health costs. And the Medi-Cal insurance they can get is not widely accepted--not even at some hospitals, Anderson said.

“Only 12% of the dentists in California even accept Medi-Cal patients,” he said. “And that number drops significantly if your are retarded too.”

The solution, he says, is raise reimbursement levels for Medi-Cal so that more young dentists will be encouraged to accept mentally retarded and developmentally disabled patients.

Even with bigger insurance reimbursements, Anderson fears that the stigma of mentally retarded patients will remain with some dentists.

“Once I saw a few of these people, I just could never turn any of them down,” he said. “I felt it was my duty to continue. My humanity told me that this was something important to do.”

But Anderson has come a long way in his perceptions of retarded patients. “When I first started treating them, I used to go home late at night, sit down by my kids’ beds and cry, I was so thankful that my children were normal,” said the father of three.

“Now I have an entirely different attitude about these kids. I understand them. I love them just as much as if they were normal. It just takes time to realize that they’re just as good and normal, in their own way, as my kids are.”

And he has reaped certain rewards for his efforts. Both on the street and in restaurants, he is constantly approached by patients and their families, many of whom embrace him and offer their thanks.

Sometimes, Anderson feels like everywhere he goes he meets his patients. While vacationing in Spain last year, for example, he awoke from a nap on a park bench to find 25 Mongoloid children gathered around, peering into his face.

“At first I thought I was dreaming,” he recalled, “that my patients had followed me to Europe. But it was just some children from a nearby school who were curious about the old white guy sleeping on the bench.”

On his frequent tours of international zoos as Zoological Society president, “I always seem to show up on the day that retarded children visit in groups. And they all come up to me. I guess they know I’m a friend.”

One day soon, however, that friend will walk away from his practice.

“I’ve been at this too long,” Anderson said. “I’m too tired, I’m too fat and I’m too gray to go on much longer. But I don’t want to leave my patients with just any dentist.

“Because there’s a big difference between care and quality care. After all, these people are part of the family now.”