Rural dental care stumbles in Senate

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By Sherry Robinson

If you live in a rural area and you have a toothache, chances are you’ll have to drive for several hours to get help.
A bill to remedy that, now stuck in a Senate committee, shows us both the strengths of our legislative system and the weaknesses. The strengths are the power of bipartisan cooperation, in this case, between Sen. Benny Shendo Jr., D-Jemez Springs, and Rep. Dennis Roch, R-Texico. The weakness is the power of one person to mess things up.
You probably know by now that New Mexico doesn’t have enough dentists. We rank 39th in the United States, according to Health Action New Mexico, a consumer advocacy group. More than a third of rural school kids have tooth decay.
Senate Bill 76 would create a new kind of dental provider, the dental therapist-hygienist, who would occupy a niche between a dentist and a hygienist. With supervision from a dentist, the therapist-hygienist could provide many services, including extractions.
The model is a program that has served Alaska Native villages. People in the village choose an individual, who receives training and then returns to provide dental care for his or her village.
“The Alaska model is a Native solution to a Native problem,” Shendo told me. “It would work here.”
Roch has observed before that his sparsely populated northeastern New Mexico district has a lot in common with the state’s reservations. Kristen Christy, executive director of the Union County Network, testified in interim hearings that Clayton has been without a dentist or a dental hygienist for 12 years. The dental therapist model would work in her community, she said.
Which is why both the Union County Network, the Navajo Nation, the Rio Arriba Health Council and other rural groups support the proposal.
Dentists are opposed. They don’t believe somebody with less training should be doing extractions and other irreversible procedures. They advocate instead a community dental health coordinator, who provides only preventative and palliative care.
Last week Shendo explained to the Senate Public Affairs Committee that the reason the Navajo Nation can’t start its own program is because the American Dental Association sued the Alaska program. The outcome was that the Alaska native villages could keep their program, but no other tribe could start one.
“There’s a huge need in the rural areas,” Shendo said. “The Navajo Nation, which I also represent, has huge issues.”
Because one of the dentists’ grievances was the potential for competition, the bill’s sponsors even added wording to restrict therapist-hygienists to shortage areas.
The gum on this shoe is Sen. Daniel Ivey-Soto, D-Albuquerque, another lawyer who loves the sound of his own voice. He peppered Shendo and Blackwell with questions so nitpicky and long-winded that the committee chairman, fellow Albuquerque Democrat Jerry Ortiz y Pino, took him to task. “You’re berating these people, which serves no useful purpose,” the chairman said and repeatedly prodded Ivey-Soto to move along.
Ivey-Soto never revealed an objective except to say the bill had “problems.” However, it was a product of the interim Health and Human Services Committee, which endorsed it.
His one relevant question: What guarantee is there that the chosen trainee will return?
Shendo responded: “At Pueblo Pintado, if someone who’s interested in doing this sits in front of their elders and promises to come home, they will. That’s the staying power of the Alaska community model. It’s the first time local communities have come up with a model that works for them.”
Works for them. Three little words that Ivey-Soto refuses to hear. The committee tabled the bill and told Shendo to work out the differences with his sanctimonious cross-examiner. In a short session like this one, Ivey-Soto’s stalling will probably kill the measure.