Special Patient Care - UCLA Dentistry

UCLA Dentistry's Special Patient Care Clinic is one of the few clinics that provides care to special needs patients in Southern California. Due to an increasingly high demand, patients may wait up to a year before their first appointment. This documentary tells the story of the people who provide and receive this essential care.

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Because of her disability and certain health problems, they referred me to three facilities in Southern California who could help me. I picked up the phone and scheduled an appointment for me a year from the day I called.

The waitlist just to get into our clinic can range anywhere between six to twelve months before they're actually able to be seen. A lot of it has to do with just access to care. There aren't a lot of dental clinics or facilities or practices that may be comfortable treating patients with special needs.

Having the capabilities versus the desire, I think, is two separate things. You know, working with this population requires much more time, much more expertise, yet the reimbursement is extremely low. Given such, I think the drive to treat this population then becomes more of a compassion or desire to help out.

A life worth living. I think part of it is very simple. Be happy with what you have, you know, how lucky everyone really is, and go out and help people. Help those who are less fortunate, and when you have a whole group of people who are here for that reason, I think we then become collectively much larger as a whole, then a collection of the individuals.

You know, when you're given an opportunity to help somebody and you've been given so much in your own life that you, at least for me, I feel like I want to give it back, you know, just try to make somebody's life just a little bit easier or a little bit better, you know, take him out of pain or give him a better smile.

None of us could do it alone. I think all of us need each other to make it work, you know, because for many of these patients, they need a lot of help in many different ways, and so it's great to be a part of that team.

In the Hospital Dentistry Clinic or Special Patient Care Clinic, we provide comprehensive dental care on a wide variety of patients. The patients that we see are typically very medically complex have intellectual disabilities or physical disabilities.

Unfortunately, many of these disabilities may coalesce into their overall condition.

So go ahead and take your mask off and just show me. I just want to look, is that OK?

Yeah. All right.

Can I take a look at that? Oh, wow. You got some silver teeth in there! Thank you very much.

Of course, you're worried about this guy right here. It's completely broken down. We'll see if we can save that guy. Thank you. That was very helpful.

OK, I did a good job?

You did a great job, actually! Thank you.

Thank you!

So I'm assuming your mom is a legal conservator then, right?

I know my mom's struggle, she's been looking for a dentist outside of the local area. And, you know, finally, coming here to the appointment it just feels great, you know, and to actually like, come in here, sit down and talk with the doctor, you know, and discuss like the whole process about it. It was very, very relieving I know for my mom and to myself, especially 'cause, you know, we're always trying to take care of my brother as much as we can.

How far did you guys drive today?

We came from Paris in Riverside County, an hour and forty minutes.

OK, what we're trying to see if someone's available and just get started on the process so you don't have to come back, is that OK?

So with that paperwork, we send to Medi-Cal for pre-authorization that takes two months to go through, but it saves you one trip because today I just did the screening, which is accepted. You get to come here if you want, then the third appointment is where we put him to sleep.

OK, so here you go. He's a pleasant 26-year-old kid. He's actually fairly high functioning. He's wheelchair-bound because the hip fracture, no allergies and they are his mom and sister. She's a younger sister, actually brushes his teeth twice a day.

It's a pretty complex machine the way we all work together to provide care for patients. We have six full-time dental residents. These are dentists that have already graduated from dental school and have chosen to do an extra year of training in general practice, as well as in the management and treatment of special needs patients and medically compromised patients.

Dr. Sung and I and Dr. Mincer are the full-time faculty members, but we have a really great team of part-time faculty members as well, both general dentists as well as specialists in different areas of dentistry to help us.

You know, it's really about teamwork, and some of the most essential parts of the team are the staff. We couldn't do what we do as dentists if we didn't have the assistants. You know, we couldn't see the patients in the operating room if we didn't have our front office staff to get the insurance authorizations and the scheduling done. And, you know, call the patients, you know, they go the extra mile. Often times they're calling doctors, they're calling, the insurance agents and telling them how important it is and how vital it is to get these authorizations so that patients can be seen. I'm very, very anxious, very, very nervous because I don't know what they're going to tell me. Honestly, because she hadn't seen a dentist since 2014 due to her health condition and her special needs, and plus me, I was working full time away from the home. So when I became a stay-at-home parent and was tending more to her personal needs, that's when I did try to get dental services. It's been, you know, me having to brush her teeth, you know, having to hold it because she can't do it. It's a sensory issue and it's a lot of pain, a lot of discomfort with the brush and her gums because of her autism. So as the course of the years went by, she's got a lot of buildup. A lot of dental work needs to be done.

This journey began in May of 2019, that's when I first tried to schedule an appointment because of her disability and certain health problems, they referred me to 3 facilities in Southern California who could help me.

The first facility they weren't able to help said because she is an adult, they only do pediatric. Next on the list was UCLA. UCLA picked up the phone and scheduled an appointment for me a year from the day I called. I made this phone call September of 2019. So a one year waitlist.

The waitlist just to get into our clinic can range anywhere between six to twelve months before they're actually able to be seen. A lot of it has to do with just access to care. There aren't a lot of dental clinics or facilities or practices that may be comfortable treating patients with special needs, or they may not be equipped to treat patients with unique needs.

I think it's bizarre that these are the only options in Southern California. These are like real slim pickings for this region. There should be more, more facilities. Yeah, there should be more options.

Stay down, stay down! Thank you, everyone.

She get the prescription?

The thing about it is had they not been able to take her today, we would have had to wait another eighteen months. So we're kind of fortunate to get in today.

Imagine the special needs non-verbal child, you know, having a toothache and the parent trying to figure out what's wrong with them, they've probably taken them to their primary care physician, you know, to see, Oh, maybe they have like an earache or maybe they have this maybe they have that and they can't figure it out. Then they finally, Oh, it's a dental issue. Then they come in to the dentist and they're told, Oh, by the way, we can't see you right now because we have a long list of patients already waiting to be seen. So you're going to have to get on this waitlist and then once we see you, we have to send a special authorization request to your insurance company that could take a couple of weeks to get back. And then you have to come back to get your child sedated so we can evaluate what's going on in their mouth.

It's just crazy. It shouldn't be this way. It really is, sometimes it's depressing. It's depressing, and we try and we strive so hard to like, do the best that we can for the special needs population. But it's like, it's like never enough.

A lot of times patients, when they talk to me and then I'm like, I, I get it. And when your kid is sick, you're like trying to think of what's wrong with them, what can I do to make it better?

And these kids or even adults, because I've seen like 60-year-old ladies come in with their special needs 40-year-old son? You know, it never ends. So I think for me, that's also changed my perspective. As a parent, because I would be neurotic thinking like, what's going to happen, what's going to happen, you know, as they get older, as I get older, you know, being a mom never stops and their illness doesn't go away either.

It's helpful to repeat to yourself that you're helping just because sometimes it doesn't feel like you are, but it's just something that you need to constantly remind yourself that you are providing a service.

So we see a lot of patients who are going through like pre radiation and you end up, they've already had so much taken from them and you end up needing to extract like five teeth.

And in the moment, it doesn't feel great because you're like, it almost feels like you're kicking the mother down, but just constantly reminding yourself that you're there to help.

When I see these patients oftentimes instead of feeling like, oh yes, I'm actually doing something great for them, I just feel this horrible sense of like shame almost. Like why? Look, it's too late for me to do anything at this point. And sometimes we see patients who haven't been able to see a dentist for years and years and years and you're like, oh my gosh, like if only we had caught this years earlier, it wouldn't be such a problem, you know, and we're faced with extracting teeth. And it's just, yeah, to be honest, I wish it were more fulfilling, but instead, it's just made me really angry. Sometimes, you know, I haven't burnt out yet or anything, and I think it's definitely incredibly important to do this sort of work.

But I think it just speaks to the character of, you know, our attendings who have been doing this year after year that, you know, something keeps them going day after day. And because I personally find it incredibly frustrating that. You know, yeah, it's great that they're here, but what about all the care that they didn't receive?

Having the capabilities versus the desire, I think it's two separate things. Very few people will be willing to do something that's this challenging. Many of these patients may not understand why they're here, and they don't understand why, much less allowing us to get in their mouth and say, open your mouth, that's a very invasive location. They may be combative, they may be vocal, they may scream.

That is extremely disruptive to any dental clinic. So for that dentist to try to be willing to do that instead of seeing a different patient where perhaps you could complete multiple procedures, it could be challenging.

You know, the average dental student graduate with three or $400,000 in debt nowadays. And if you're treating this patient population, it is not financially rewarding or it is very difficult to make it financially rewarding. And given such, I think the drive to treat this population then becomes more of a compassion desire to try to help them listen to your heart.

Let me listen to your heart. Very strong heart!

So I was born with cleft lip and palate, and that's a condition where you need a lot of medical treatment, a lot of surgeries, as well as a lot of dental work. What's really crazy is I was treated here at UCLA when I was a baby and when they helped build my smile and I grew confident, I really fell in love with the field and I wanted to be just like them.

So being a dentist now, here, I've treated patients with cleft lip too, and it just feels like a big full circle. And I feel really honored to have this privilege. I hope that one day the doctors that treated me would know how much they have given me and be proud that I'm also returning the gift back to another patient, another family, another population.

Do you know how far we traveled? On the second time we actually stayed out there to avoid the traffic, because Alex, he works. So it was a work conflict. We wound up spending the night out there instead of coming back home.

I'm trying to wrap my head around that. In all of Southern California. UCLA is the only facility able to provide services. I'm glad they're able to help, but I guess it goes deeper than the dental. She does have issues with her liver and she was pre-diabetic.

You know, she can't communicate that to me. How’s she going to say hey this feels unusual mom, I need to see a doctor. This doesn't feel right. There's no way she can communicate that to me.

So that's one of the things that I worry about constantly underneath, you know, all the things that I wish she could tell me as far as how she's feeling, you know what she wants to do with her life. What she wants out of life.

There was a time when she could speak. She stopped speaking between 18 and 24 months. Just stopped. There was no isolated incident, there's nothing traumatic. She just started to regress vocally, until she stopped talking.

She used to mimic. She used to sing. And one of her last words was Amen then all of the sudden no more words. We thought that thought she was losing her hearing, we had no idea, no clue that it was autism.

She was four years old when I got the diagnosis. To understand what it really was, and how it's a neurological condition that's lifelong. Yeah, I was blown away.

When I first got the diagnosis, I broke down on the ground and just cried because I didn't know, like, what do I do now? What's going to happen to us? And I didn't know. I felt like I was drowning. I just lost control on everything.

It just took a toll on me mentally. I had to leave my marriage and go live with my parents and start over. Went back to work, back to school. It took me ten years just to get to where I am now since the diagnosis. I was working 40 hours a week in an office trying to take care of her, you know, just trying to dig myself out of that hole.

So it is a lot of hard work. I was a single parent who worked 40 plus hours a week had to leave home. I had to leave her just to earn a living, and I'm trying to navigate being a special needs parent on top of that. I just burned the candle at both ends.

It was hard. It was devastating, but I'm not devastated now. I love her. I think it's the best thing that’s ever happened to us.

In order to better serve special needs populations, I think a lot has to happen. There's no silver bullet. You know what I mean? There's no like one way that we can fix things so that these folks have access.

So I think there could be broader conversations around, well, how do we find funding? How do we ensure that the most vulnerable members of our society are taking care of, you know, maybe a moral reckoning within our own profession and also just within health care generally?

Choosing this career path is not an easy choice, because it's fiscally very, very challenging. Working with this population requires much more time, much more expertise. Yet the reimbursement is extremely low. So in a logistic manner, I think it would be helpful if the insurance companies recognize that and perhaps reimburse as appropriately.

The other aspect, of course, you need the students, residents being exposed to this patient population, which is something we do. So I'm very proud of that.

With the UCLA School of Dentistry, the dental students also rotate into our clinic. During that rotation, we make sure we spend ample amount of time to show them that it's OK to treat this population, and not only is it OK, but there are ways that they should all know how to manage and hopefully comfortably treat them in the future.

So this is a really, you know, great rotation that Dr Song's created, where we're able to sort of get these students to see what they learned in the classroom and how it's applied in the clinical setting. So they learn a lot about, you know, patients with different medical complexities like cardiac patients, cancer patients and then also a lot about different types of special needs patients.

In the dental school they don't really get the opportunity to treat these patients themselves. So in our clinic, they're able to, you know, see how we treat them and what we look for and what they should look for in private practice.

Something that they don't realize is how common autism actually is. You know, one in 58 individuals, when they have kids, probably two people in their class are going to have a child with autism, and it really is more common than they think. You know, it's a spectrum and each patient needs to be looked at individually. Some can be treated without sedation and might not need to come to a clinic like this, and they can be treated in the private sector.

So by teaching these students, I'm trying to make them more comfortable, more confident in treating these individuals so that we can take a little bit of pressure off of clinics like ours and hospitals. And these patients can hopefully be seen in private practice where the rest of their family is seen so that they don't have to be seen, you know, in a special environment.

I did go to dental school here at UCLA, so it just kind of happened to be that what I was looking for in a residency program was exactly what UCLA had to offer. So I was, you know, very happy and very content to stay put. I was very familiar with the cast of characters involved, I knew them already. They taught some of my classes. So I was very familiar with them and what I expected from them.

It's definitely a labor of love and I see it in all of them. You know, clearly, if they wanted to be making the big bucks they wouldn't be here. So yeah, that's refreshing. I mean, it's maybe a little bit more in line with what I want to do.

So I went doing school at UCLA upon completion. I did my residency here and I was fortunate enough to really enjoy it. And I like to think I excelled in it, and when a full-time position opened up a couple of years later, I decided to apply for it and I've been here ever since, so it's been since about 1992.

I've been here this long is for several reasons. One, I mean, the main thing is I enjoy it. I do truly enjoy doing my dentistry. I think it's something I've enjoyed throughout my career, but I also really enjoy teaching.

When you reach that one student or one resident where it motivates them to push them to another level, that's extremely rewarding to me and to hear about former residents carrying on the torch, making a difference. And the ones have gone on to different institutions and continue to teach. And then perhaps their students will continue to do what we did. So that ripple effect. Yeah, that in itself is priceless. You know, I don't think I could put a, I guess a price tag on that, so in essence, I actually find myself to be very lucky to get to do what I do, and there's just nothing else to it. It's good. I'm OK.



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