Skid Row Dental Clinic Feels Bureaucracy’s Bite

When $75,000 worth of donated dental equipment landed on the loading dock of a skid row shelter, relief seemed on the way for the receding gums and rotted teeth of the city’s most neglected mouths.

USC dentistry professor Alvin Rosenblum thought he had cleared the highest hurdles in his effort to start a free clinic for the homeless at the Union Rescue Mission.

He had secured the equipment. He had found the space. He had students ready to work.

What he didn’t have was a building permit.

A year later, the dental chairs are still in boxes. Teeth on skid row are still going untreated. And the shelter’s building engineer waits in countless lines at the Department of Building and Safety.

“There is so much lip service about taking care of needy people,” Rosenblum said. “But when it comes down to it, we get hung up. It’s disheartening.”

The proposed construction to accommodate the clinic is minor. The mission needs to add doors to three non-load-bearing walls, build some partitions and repair plumbing and electrical wiring to install six dental chairs.

But the permit process has dragged on for months, costing the mission thousands of dollars and thwarting the efforts of those who wish to help.

City officials concede that the process is confusing and often time-consuming and say they are working to streamline the system.

But they are not working fast enough to satisfy the mission’s building engineer, Richard Anderson. Flailing his arms in disbelief, Anderson told how it took three days to get past an ordinance that required him to increase parking for patients.

He paused, waiting for his message to sink in:

Homeless patients don’t drive cars.

The mission paid an architect at least $100 an hour to spend three days wading through bureaucratic regulations, Anderson said. And that was just one--real or potential--setback.

In Los Angeles, he said, each piece of equipment installed in the clinic must be approved by the city, even if it has been approved elsewhere in the state. “Now, I’ve got to find out if these chairs have been approved by the city,” he said, adding, with eyes flaring, “What if they’re not?”

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But Anderson said his biggest gripe is not so much with the regulations that require him to amend endless details on his blueprints. He said there’s no smooth, easily understandable and logical way to get through the city’s permit process.

“You get in line to get your stuff,” he said. “Then you get out of line, get your receipt and get back in the same line.”

Last Wednesday, he said, he arrived at the department’s office in the morning and didn’t leave until 4:30 p.m. Often, he said, he may wait more than an hour and a half in one line only to find out it’s the wrong one.

He said only his faith in God is able to temper his frustration.

“Normally I say to myself, ‘This is not eternity,’ ” he said. “I’m not going to be frustrated in eternity.”

Anderson said there is a good rationale behind most regulations, and that complying with any individual requirement is not that onerous. It is the cumulative effect of dozens of seemingly minor regulations that takes a toll. And some regulations do not originate with city bureaucrats.

Changes in the federal Americans With Disabilities Act require the mission to reverse the swing of two bathroom doors. When the building was completed three years ago, the doors fit the code. Now they don’t. That’s $1,000 per steel doorway, Anderson said.

As far as negotiating Los Angeles’ permit process, Victor Penera, the Building and Safety Department’s chief of engineering, acknowledged that clients can be confused.

He said a task force Mayor Richard Riordan established three years ago streamlined the arcane permit process when business and civic leaders reported that it had caused a 50% drop in construction over five years.

Riordan’s press secretary Noelia Rodriguez said the mayor approved 66 of the task force’s recommendations to cut red tape, half of which he implemented by executive order. The others, she said, are working their way through the City Council.

Even so, she said, the city still loses businesses and other organizations due to what she called the byzantine permit process.

“When any type of organization can go across to Burbank and get away from red tape, it’s a no-brainer,” she said. “People would do that.”

But Penera said the building and safety office has become more user-friendly and is trying to reduce confusion for those who are not accustomed to the process.

“We’ve addressed that by having a greeter at the entrance,” he said. “He’s there to help you.”

Penera said case managers are also on hand to sit down with applicants, explain the process and work through all potential hitches in their plans.

But Anderson said no one has ever greeted him or informed him of case managers.

“Oh no, no, no, “ he said. “If they got that going, it’s the best-kept secret in City Hall.”

Delays have become so routine that Rosenblum has stopped seeking donations. He has no answer to benefactors’ questions about when the clinic is going to open.

Regulatory nightmares convinced Rosenblum’s colleague, Dr. Charles Goldstein, that Los Angeles was not the place for his good works. Goldstein runs a mobile dental clinic that treats poor children from Baja California to the San Joaquin Valley. More than 70,000 children have been helped since he began in 1971, he said--all outside the city of Los Angeles.

“It’s too tough to work here,” he said. “It’s too difficult because of the regulations.”

In Goldstein’s case, Los Angeles Unified School District health regulations were the problem. His dental students are required to get tuberculosis tests every six months, which he said is unnecessarily stringent.

Meanwhile, at the mission, many of the poor and homeless do not have Medi-Cal and can’t find regular dental treatment. Last week, a 27-year-old woman named Cindy brought her 2-year-old daughter from her nearby apartment to get food.

“I have problems with my gums,” Cindy said. “They bleed. It’s painful. I try not to eat meat because it hurts so bad.”

Her teeth are yellow and her gums have receded to expose the roots. Big gaps mark where she had pulled out dangling teeth with her bare hands.

She said she looked forward to using the free clinic at the mission mostly because she doesn’t know where else she can get treatment for her daughter, who does not have Medi-Cal.

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Goldstein said many homeless people suffer from periodontal disease, and that he’s seen more than his share of infections and swollen faces as a result of neglect.

“In most cases it’s not life-threatening,” he said. “But it’s pain and it’s suffering.”

Missing front teeth can often be a major hindrance in finding a job. Some employers think missing teeth indicate laziness or stupidity, Rosenblum said.

He said the clinic would offer all the services of a general dentist, including emergency treatment and cosmetic work for those looking for jobs.

He said USC would also start a program to teach parents and children preventive care and would distribute fluoride and sealants to prevent decay. He said the mission’s clinic would be comparable to the largest free clinic in the county, the Los Angeles Free Clinic at Beverly and La Cienega boulevards.

Dental students, supervised by faculty, would do the bulk of the work, Rosenblum said. He estimated that students would handle 60 appointments every week.

“There are people who need attention,” said Rosenblum. “A lot of people could have been treated in this last year.”