Clinical Trial

[February 6th, 2008]

For Gregory Fowler, dental care isn’t a routine visit. It’s a life-saving measure.

And for the 651 other HIV-positive patients who—like Fowler—turn each year to Russell Street Dental Clinic in North Portland for care, low-cost alternatives simply aren’t available. Not in Portland. Not in Oregon. Not in the entire Pacific Northwest.

“We’ve been really lucky in Portland to have Russell Street Dental,” says Fowler, 49.

But the crucial services the clinic has provided HIV-positive Portlanders and other high-needs and low-income residents for 30 years are now threatened.

That threat comes from Oregon Health&Science University’s reaction to a Dec. 28 decision by the Oregon Supreme Court.

The case involved Jordaan Clarke, a 3-month-old boy who, in 1998, suffered permanent brain damage in an OHSU recovery room after successful brain surgery. In December 2007, the court determined that injured patients at OHSU could seek unlimited liability claims against the hospital, which had been protected by a $200,000 liability cap because it is a public institution.

OHSU said eliminating the $200,000 cap would drive up its insurance rates to the point that it would require $30 million in cuts elsewhere.

One piece of those potential cuts would be closing the Russell Street clinic, which is affiliated with OHSU’s School of Dentistry.

Now the impending closure is alarming the small but vulnerable community of patients who depend on the clinic for low-cost dental care, crucial services that are subsidized by federal grants, the Oregon Health Plan and Medicaid.

Though OHSU owns the building and land at 214 N Russell St., it doesn’t charge the clinic rent or fees for utilities. The clinic is otherwise financially independent from OHSU; it pays all 30 of its employees.

For people with HIV, an oral infection can lead to death if the body can’t fight the bug. And many anti-retroviral medications promote tooth decay, undermining patients’ quality of life and making them susceptible to those infections.

“With a compromised immune system…oral care is paramount,” says Dr. Bob Johnson, a dentist who is also the clinic’s director. “You simply cannot afford an oral infection.”

A final decision about the clinic’s fate won’t be made for several weeks. The uproar, however, is already huge.

Jean Ann Van Krevelen, executive director of Cascade AIDS Project, says her group has pledged to help the clinic stay alive, because the alternative would be “disastrous.” In 2007, the clinic served a total of 4,000 patients. But it also recorded 14,000 visits, including 3,025 emergencies.

At the same time, the clinic served as a training ground for 100 dental students from OHSU and 60 hygienists-in-training from local community colleges.

“We can’t let a resource like this go,” Van Krevelen says.

Adding to the frustration is the fact that some of Russell Street’s supporters don’t trust OHSU’s motives for threatening to close the clinic. They say the warning could be a political maneuver to force the Legislature during its current one-month session to speed efforts to re-impose a limit on liability claims.

OHSU denies that.“This is not a public-relations ploy,” says Dr. Joseph Robertson, president of OHSU.

Instead, OHSU says the decision is purely a financial one. “We have an obligation to the state and the rest of our patients to maintain a sound chassis,” Robertson says.

A spokesman for OHSU says the clinic runs a deficit of $600,000 a year, about 0.04 percent of OHSU’s annual $1.4 billion budget.

That figure, too, is a source of contention. The number is an estimate from OHSU based on a small operating window. In other words, it’s an extrapolation, not actual accounting. “If you’re looking at a $600,000 shortfall, that’s hard to make up,” says Johnson, the clinic’s director. “But if you’re looking at a $50,000 to $100,000 shortfall, that’s a manageable amount. That lends itself to a financial solution. And that’s where I believe we are.”

Robertson earned more than $1 million with bonuses in 2006, according to an annual report from Oregon Health News . His base pay in 2008 is $780,000—more than half the entire annual $1.5 million budget for the Russell Street clinic.

“We have been discussing executive compensation with human resources as recently as yesterday,” Robertson said last Friday, Feb. 1 when asked if he would accept a pay cut.

Closing the Russell Street clinic shouldn’t be an option, supporters say. “The safety net system in Portland cannot possibly begin to absorb the services offered at Russell Street Dental,” Johnson says.