04/08/09 — No extra money likely in Wayne for AIDS and dental programs

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No extra money likely in Wayne for AIDS and dental programs

By Steve Herring
Published in News on April 8, 2009 1:46 PM

Working under the shadow of a multimillion-dollar revenue shortfall, Wayne County commissioners Tuesday appeared for the most part sympathetic to financial needs in the Health Department's dental clinic and HIV/AIDS program, but stopped short of promising more money.

"Right now, we have a $7.5 million revenue shortfall and requests that are probably, I would say at this point, $6.5 million, so if you add those up you are short $10 million to $11 million right now," County Manager Lee Smith said. "What I would recommend, and what I am telling departments for the most part, is request what you need, but understand that you are not going to get all that.

"There will be no additional revenues this year. Therefore, if it is a priority I am going to ask departments to reprioritize their existing budget, cost shift to other areas because there is going to be no new revenues and it is going to be tough."

Smith said he had spoken with Health Department Director Jim Roosen several times about the importance of the dental program.

"We know that if we don't take care of the dental issues we are going to have other issues. But without additional revenues we are going to have to reprioritize using the money we have.

"We will look at it April, May and June and come back with a proposal."

This week and next, budget committee meetings for all departments will be held, he said.

In prior interviews, Smith has said that reductions in the number of county employees over the past several years and underestimating revenue projections should help lessen the budget sting.

Commissioners repeatedly have said they do not plan to increase taxes this year.

After hearing a plea from Dr. Tiffany Harper, who manages the dental program, Commissioner Sandra McCullen asked Smith if any short-term relief is available.

Smith's reply was a somber reminder of the deficit and reduced funding.

"We will have to reprioritize with the revenues that we have," Smith said.

The county has eliminated more than 100 county positions over the past several years by combining jobs and not replacing people as they retire.

However, during the board's Tuesday session Roosen said that drastic growth in HIV/AIDS cases in the county had reached the point that another social worker is needed.

"There is a need for a person, a social worker, to oversee a program that connects patients to agencies and that could help find funding," he said.

Roosen estimated the salary and benefits would be $50,000, half of which would be paid for by the county.

The county is in the grip of an HIV/AIDS "epidemic" that started in the 1980s, Roosen said.

"I am very concerned and there does not look like there is an end in sight," he said. "It is just getting out of control.

"The best control measure I have right now is education."

Currently 300 people in the county are infected, Roosen said. Wayne County ranks 19th in the state in new HIV/AIDS infections and 10th in the number of cases of AIDS reported.

"That is an indication we are not doing a very good job with these folks who have HIV infections," Roosen said.

Roosen also spoke to commissioners about the department's dental program.

"Productivity has stayed the same, reimbursements have stayed the same, but our numbers have increased and as a result we are earning less money and we are having to turn away a lot more uninsured patients," he said.

Just under 400 patients are seen monthly at the dental clinic, and the Health Department board has mandated that 90 percent of those seen have insurance, while 10 percent are uninsured.

"My point is that a lot of Wayne County residents are not getting access to the system," Dr. Harper said.

The clinic provides a full range of dental services such as simple extractions, surgical extractions and periodontal care. It does not provide orthodontic care. Patients range from age 5 to geriatric patients, and referrals come from hospital and the WATCH program.

"Patients are unaware that we charge fees. Even though our fees are extremely cost effective we still have to charge a minimum fee," Dr. Harper said.

She said she also acts as hygienist as well as dentist. She has two assistants and a receptionist.

The clinic, she said, provides comprehensive care and tries to educate patients.

"The services are performed at a fraction of what it would cost at a private dental practice. So we are trying to juggle how to meet these expenditures with very little revenue," she said.

Dr. Harper asked commissioners to help by subsidizing the program.

Commissioner Jack Best asked how much money was needed. Dr. Harper said $100,000.

Roosen said that $20,000 would be a "good start."

Dr. Harper added that $30,000 would be even better.

"I think you know that the down economy has affected everyone, even county commissioners," Commissioner Andy Anderson said. "I know some can afford low fees. Is it possible to raise the fees for those who can pay?"

The fees were raised twice last year, Dr. Harper responded. Also, raising the fees won't help since the people who couldn't pay to start with would still be unable to pay, she said.

"You want $20,000 to $30,000 or more, but the people in this room will hurt if the county increases taxes," Anderson said. "You need to look at need and may need to raise fees."

All HIV tests are done by appointment only. To make an appointment, call (919) 731-1000 ext. 1274, between 5 p.m. and 6 p.m.

The dental clinic is open Monday through Friday from 8 a.m. to 5 p.m. To make an appointment, call 580-4050.