By JOHN EBY
Dowagiac Daily News

CASSOPOLIS – When Cassopolis Family Clinic began collaborating with Administrator Jeffery L. Elliott, it wasn’t long before Executive Director Mary Geegan Middleton got a call from his office about a $2,200 bill for dentures.

“We can’t afford to do that,” she said Tuesday. “We can afford to do extractions, fillings and cleanings” of teeth. “We have a limit of $400 per patient for dental services. That goes a long way. I plan to continue looking for grant opportunities to provide dental for our patients without actually having to create our own dental service here. It just doesn’t make sense to recreate the wheel when Jeff’s got great, state-of-the-art clinics down the street. We’re going to look for money to continue that collaboration with the health department. We’re also talking with our community mental health agency (which in the early 1980s had its offices at 109 School St.), Woodlands Behavioral Healthcare Network, about the possibility of collaborating with them on some counseling services here on-site.”

County Commissioner Dixie Ann File, R-Cassopolis, asked Elliott about dentures costing $2,200 when television offers promote them for $350.

“A denture alone is $450 (times two with an upper and lower), then you have all the extractions and to prepare them for dentures,” he explained. “My role as the director of public health is not to compete with the private sector. My role is to make sure if there’s no other recourse for these individuals to go with Medicaid and/or no income, that they have a place to go. We’ve always had this M*A*S*H unit with two chairs and a dentist until it expanded two years ago with high-tech stuff.

“We see 12,000 patients. Those 12,000 people are telling us that we’re doing something right in these two counties,” he said.

Elliott added, “We’re touching only about 21 percent of the market out there for this population. I look at the Medicare and Medicaid system as an underinsured program. What they provide is not what everybody seeks. Medicaid provides only certain procedures. There are no crowns or bridges or that kind of stuff paid for in the dental department. Every time Southwestern Medical has a budget issue, they get another 4-percent reduction. How much can private docs handle when they keep getting cut, cut, cut? The biggest problem we see, even with the type of referral system we’ve built here, most of these individuals when they come in are train wrecks. It’s not like they’ve been brushing their teeth for the last 25 or 30 years, they really have issues – oral health disease and gum disease. It’s a lot of work to take care of some of these folks.”

File said a friend who uses the service was “tickled” to get a cleaning and X-rays done for $75.

“We hope to emphasize the prevention side of all of this,” Elliott said.

“Take care of these youngsters and give them good habits. I wish I was in every school and every class to take these 6- to 12-year-olds when they lose their baby teeth and get their adult teeth in. Then we don’t see dentures at 25 years old – or 19.”

Middleton said Cassopolis Family Clinic distributes toothbrushes, toothpaste, dental floss and educational brochures. “It’s helpful if you don’t have any money,” she said. “We’re trying to promote oral health.”

Elliott complimented Middleton for “all the work you’ve done in this county.”
“I’ve been involved in this county since 1990 and in Van Buren since ’83 and have always had a good working relationship with you. I think we have one fault – that we’re still known as the best-kept secret. I think if people understood what community health centers do for the community … the health care industry would be a lot better. We need the ability to get the message out that we do have quality docs, we do have quality staff, we do have quality services. Community health centers add a lot of value to a community. I agree with (Medical Director) Dr. (Frederick) Johansen – they’re going to be around as a major player in whatever you want to call this health (reform) thing coming out we don’t know anything about. The more opportunities we have to work together, the better off this community is going to be.”

An example of that is Frank Squires Elementary School Principal Tracy Hertsell.
“We’re in dire need,” he said. “I came out of the board meeting last night and had to get rid of a teacher. Those kind of things are happening on a daily basis with the state of the state. It’s very tough. We’ve actually had the conversation of whether we could, somehow, have a nurse in our building. We’re 73 percent free and reduced (lunches) at Squires School, and I’m sure that number will be up this fall because families are going out of work by the day. We had a nurse under a three-year grant, which was the most wonderful thing that’s happened in my school. The money went away and my nurse went away. Families are desperate right now and they’re taking desperate measures,” such as visiting emergency rooms.
“They don’t go to the doctor when they should and two months later it’s tragic. The Family Clinic has been a blessing to us with its sliding fee scale,” Hertsell said.

Elliott employs a fulltime health promotions director, Emily (Diederich), who can come in and talk. We have a substance abuse counselor. Access us. We’d be more than happy to help as much as we can. We realize you guys can’t any longer have counselors and school nurses. And it’s probably going to get worse.”

Board of Commissioners Vice Chairman Ron Francis had asked whether more could be done in the public school setting.

Dr. Johansen, as someone who has served on school boards and is a parent of teachers, responded, “They’re asked to do a zillion things. Check for drugs. Check for guns. Help self-esteem. Educate them. Test them incredibly often. Find out if they’re being bullied or abused. It’s pretty tough. Health classes, in general in Michigan, have dropped off. Schools do less and less of the Michigan Model, which had some pretty good stuff in it. I helped put some of that together. Benton Harbor schools don’t have a sex education program. Figure that out.”

As Middleton pointed out, “Community health centers are charged with doing a lot of things – outreach workers, dental, behavioral health, patient education, maternal-infant health programs, pregnancy services. But why recreate the wheel and go through all that expense again if somebody else in the community offers it? We looked long and hard at the need to do OB care. There’s no OB care in Cass County at all and very little accessible OB care in Berrien County until we created the current model in South County. There is a provider of obstetrical care in North County. We want to position ourselves to have collaborations with other providers and not feel like we need to do it all.”