SAN JUAN, August 1 - Operation Lone Star’s free dental care service at PSJA High School could have provided care for about 4,000 patients this week. Instead, the number of dental patients seen will likely be around 900.
The reason is that many dental chairs have been empty all week. Remote Area Medical, which provides free medical care to people in remote areas around the world, has been handling dental care and vision care for Operation Lone Star. The group set up 40 dental chairs at PSJA but only had nine dentists. So, hundreds of people in acute need of dental care have been turned away. Many had waited patiently overnight to see a dentist.
The blame is being placed on the State Board of Dental Examiners, which, according South Texas elected officials and Operation Lone Star organizers, has made it very hard for RAM to bring in dentists from outside of Texas. Calls to the State Board of Dental Examiners were not returned at press time.
“We could have had out-of-state doctors that could have come in, wanted to come in and had permission to come in. But it is the credentialing they do not want to go through. They do not want to go through paying fees and all the associated paperwork,” said Ron Brewer, director of clinical services for RAM.
Brewer said RAM set up 40 dental chairs at PSJA and had nine dentists. “We hoped to bring in enough dentists to fill the 40 chairs we set up but it wasn’t to be.” He said the “magic number” RAM works by is each dentist seeing 20 patients per day. That would mean 4,000 patients over the course of the week-long program. However, because it only has nine dentists, only about 190 patients are being seen each day. “We have turned a lot of people away,” he said.
Brewer said things are so much different in other states. “In Tennessee, if a dentist from out-of-state and has a valid license we check it. If there is nothing wrong they are free to come in and offer their services for a weekend or a week. We have also done it on the Indian Reservations. We got copies of the licenses, the dentists went in and started work. If they can cut the bureaucracy and the red tape in Texas I think we can get doctors in here to work.”
Asked what needs to happen to fix the bottleneck for next year’s Operation Lone Star, Brewer said: “If legislation was passed that cleared the way for out-of-state doctors, we could do more. The major thing patients want is vision and dental. Eighty percent of the patients want this.” Brewer said RAM could even come to the Rio Grande Valley outside of Operation Lone Star if the out-of-state dentists issue is resolved. “We could not do it year round because we have other commitments. But, we could do more clinics in the State of Texas. If the legislature allows it, we can come. Legislative action is better than a waiver.”
The U.S. version of RAM was started in 1985. It has now hosted 701 special operations in the country. Hundreds of thousands of patients have received free care from around 80,000 volunteers. “The volunteer force is out there they just need to make it easier for them to volunteer,” said Stan Brock, founder of Remote Area Medical. He told the Guardian of his frustration.
“The most successful projects we do are in states where they allow doctors of all specialties to come in to provide free care for the underserved. We changed the law in the state of Tennessee in 1997 and it has been enormously successful. About 60 percent of all the providers are from places like California and New York. They come at their own expense and it is a guaranteed source of help. Most states do not allow that and Texas is among them,” Brock said.
Brock said he understands the State of Texas did something to change the law with respect to dentists, but not other medical specialists. “You have to make it simple to come otherwise the doctors say it is easier for me to volunteer my services in Guatemala than it is in my own country. You must not put hoops for them to jump through after you change the law. Some of the requirements they put in place were rather tedious. And so we were not able to persuade many to come with us.”
Brock said when RAM asks U.S. patients waiting to get medical help what they want they all say dental and vision care. “Yes, they want to see a medical doctor but they - particularly adults - are preoccupied with services they cannot get through government sources, and that is oral health care and vision health care. Those are the two specialties we need to pay attention to, we cannot forget the patient who cannot afford to go to a dentist or an optician.”
Brock said RAM was at the Wise County Fair Ground in southwest Virginia last week. “We had 1,500 volunteers from all over the country. They saw 1,000 dental patients in two days and we extracted over 4,000 bad teeth and filled and saved about 2,000 other teeth. So, it is obvious where the need is. It is in the pain and suffering from bad teeth. If you set up a 100 dental chairs as we did in southwest Virginia and you have 100 dentists standing behind those chairs it works.”
Brock said from what he has seen this year at PSJA and last year at Brownsville, Operation Lone Star is a wonderful operation. “What an opportunity it was with 40 dental chairs. It is sad we only had nine or ten dentists,” he said.
Brock said RAM has been asked by health officials in Houston to provide medical care. “We get a lot of requests to come to Texas. If they change the law, Texas would be on a regular schedule for us.”
Dr. Brian Smith is Region 11 director for Texas State Health Services. Smith said dental care and vision care are always the most popular services with Operation Lone Star. He was asked why the State Board of Dental Examiners had so much red tape when it comes to allowing out-of-state dentists to come in for charity events like Operation Lone Star.
“We tried working with the dental board early on. I started in December trying to work with them but bureaucracies are what they,” Smith said. Asked how things could be improved next year, Smith said: “Try to encourage them (the State Board of Dental Examiners) early on. That would help. It was the process itself which caused problems for us.”
State Rep. Ryan Guillen, D-Rio Grande City, said he was very disappointed to learn thousands of Valley residents were going without free dental care under Operation Lone Star. He said he would file legislation if necessary to make it easier to get out-of-state dentists to participate.
“We used to do dental at every Operation Lone Star site. Now it is down to one site. We used to do Operation Lone Star over two weeks. Now it is down to one week. The demand gets greater and the service decreases. It is very sad,” Guillen said.
“It has been hard to get Texas dentists here. So, I am going to look into this to see if there is a way to make an exception for out-of-state dentists. Operation Lone Star is great. The demand is great. If there are dentists from out-of-state that are willing to help we need to take advantage of that.”
Dr. Armando O'Caña is school safety director at La Joya ISD. His school district hopes to put on dental and vision care services with RAM next summer as part of Operation Lone Star. O'Caña said he was angry to learn so many obstacles had been put in the way of out-of-state dentists coming to the Valley.
“I have asked Representative Guillen to work on legislation. We need a waiver for Operation Lone Star. We have a lot of poverty and our region would have benefited tremendously from having an additional 30 dentists here this past week,” O'Caña said.
State Rep. Bobby Guerra, D-McAllen, sits on the House Committee on Public Health. He said he remembers legislation being passed during the regular legislative session this year that would allow out-of-state dentists to come into Texas to work at charity events. He checked with his staff and said his recollections were correct. He said House Bill 1491, authored by state Rep. Dan Branch, R-Highland Park, was passed into law.
San Juan Mayor Pro Tem Armando “Mando” Garza said he was concerned to learn so many dental chairs had remained empty all week. “We have done studies in the colonias and we know children do not go to school because of dental issues. It impacts their ability to learn and perform in the classroom. It also impacts adults. People are missing work when they have dental problems and that hits our bottom line. We need to address this issue. It is frustrating. We cannot seem to get out of our own way,” Garza said.
All the VIPs that gave comments for this story were interviewed at a luncheon PSJA ISD hosted on Thursday to celebrate Operation Lone Star. Luanne Southern, deputy commissioner for the Department of State Health Services, spoke at the luncheon. However, she did not want to speak to reporters after and directed questions to public information officer John Villarreal. Villarreal was asked why so many dentists’ chairs had sat empty all week. He said he could not answer the question. “I just know that Texas has very stringent laws and regulations in place when it comes to dentists. I wish we could have seen more patients but we are still seeing a lot of people that would otherwise not have dental care. RAM is a greater partner to have,” Villarreal said.