February 14, 2003 -- Letter from Bay Legal against eliminating Adult Dental Services

BAY AREA LEGAL AID
WORKING TOGETHER FOR JUSTICE

February 7, 2003

Edward A. Chow, M.D.
President Health Commission
101 Grove Street, Room 311
San Francisco, CA 94102-4505

Re: 2003-04 SFDPH Budget/Adult Dental Services

Dear President Chow,

On February 5, 2003, Dr. Katz presented the proposed 2003-04
Department of Public Health (DPH) Budget to the Health Commission. By
its own assessment, this budget seeks to reduce or eliminate important
health care programs, including many that serve San Francisco's
poorest residents.

By state law, the City and County of San Francisco (CCSF) is required
to ensure that its indigent residents are able to obtain the basic
necessities of life, including necessary medical services. Reductions
and eliminations on a scale such as is being proposed in this budget
raise serious questions about whether the CCSF will be able to meet
its responsibilities to its medically indigent residents.

Even this early in the process it appears that the CCSF is planning
cuts in critical health care services that, if implemented, will
compromise its ability to provide necessary medical services to
San -Franciscans who have no other means of accessing needed care.
Among the proposed cuts, the budget seeks to eliminate Adult Dental
Services. For medically indigent adults, this will mean that there is
no longer anyplace they can receive needed dental treatment.

A county's duty to provide necessary dental services to its medically
indigent residents is well settled. In Cooke V. Superior Court, 213
Cal.App.3d 401, the court held that counties must ensure that
appropriate dental services are provided to their indigent patients so
that they are not forced to endure suffering from dental pain and
infection. The court ruled that California Welfare & Institutions
Code §17000 obligates counties to provide "medical care", not just
emergency care. DPH's proposed cut of all adult dental services would
take the CCSF to a level below even that which was ruled illegal in
Cooke.

Although the CCSF must fashion a balanced 2003-04 budget, it may not
do so in ways that sacrifice the right of its poor residents to basic
medical care, such as by eliminating access for medically indigent
adults to necessary dental services. DPH's effort to eliminate this
service not only runs counter to established state law but is contrary
to its own strategic plan which requires that priority be given to the
most vulnerable groups when apportioning limited resources. Adopting a
budget which proscribes indigent county residents to enduring dental
pain and infection due to lack of available services does not satisfy
either of these mandates.

The Health Commission should reject this proposed cut and direct DPH
to include sufficient funding in its budget to continue providing
adult dental services. If you have questions or would like to
discuss this issue, please do not hesitate to call.

Sincerely

Michael Keys,
Staff Attorney

cc:

Mitchell Katz, M.D., Director of Health
Health Corn mission Budget Committee
Samantha Stephen, Director, Adult Dental Services Primary Care
Aleeta Van Runkle, Deputy City Attorney