Bay Area Reporter - May 11, 2001
Katie Szymanski

There is going to be "hell to pay," said Gowdey in response to the recent decision by the San Francisco Department of Public Health's AIDS Office to discontinue Ryan White CARE funding to Community Dental, a nonprofit grassroots organization founded and funded as an alternative to dental schools.

In Community Dental's place, the University of California at San Francisco's School of Dentistry has been awarded the CARE funding specific to decentralized dental services, so people with AIDS will still be able to receive free care. But the work will be done by dental students, a factor that Community Dental doctors and patients alike say is a disadvantage and contradicts the very definition of decentralized services. And, according to Gowdey, the DPH decision to award the funds to UCSF over Community Dental occurred because of the cozy relationship between the college and the department, a relationship that resulted in ignoring HIV Planning Council recommendations and cheating PWAs out of the best available services.

Not so, according to the technical review report issued by the DPH decision-making panel charged with selecting the recipient of CARE funds.

The report cited many weaknesses with Community Dental, including the fact that the agency's proposal for renewed funding "does not address the Tenderloin and shows no experience there," and that the demographic data shows "a large number of Caucasian males being served relative to the total number of clients served." Although listed strengths of Community Dental included the notation that the agency has been providing services for a number of years and that it has good outreach strategies, additional weaknesses of the proposal included, "There is no discussion of HIV discrimination in barriers to care or socioeconomic barriers;" "It is unclear ... why more patients are served in the Castro site versus the Mission site [and] why the full-time employees are lower [fewer] at the Mission site." Additionally, there were no strengths listed for Community Dental's fiscal management. In summary, the report seemed to take issue with the high cost of Community Dental's program as well as what on paper appeared to be a service that favors white Castro men.

Gowdey, it should be noted, also is the director of the University of the Pacific Dental School, which receives CARE funding for centralized dental services. Centralized services, he said, are supposed to mean schools and institutions, while decentralized services are supposed to be community-based, and the HIV Planning Council mandates that community-based programs exist outside of dental schools and within the target communities where HIV is most prevalent. Additionally, he is a member of the local HIV Planning Council, which determines service categories that should be funded with the city's CARE allocation; the planning council does not award individual contracts for service.

Paper versus practice

But the same report that criticized Community Dental gave absolutely no demographic data for UCSF's dentistry school, and cited as weaknesses the fact that UCSF's proposal had "no mention of number of past clients, nor was demographic data presented." UCSF also had "no discussion of Tenderloin services;" and its outcome objectives had "no strengths noted," according to the report. Overall, the strengths listed for Community Dental exceeded those listed for UCSF, according to the report.

"The panel assumed gay white men came to the Castro and Latinos to the Mission, but people from all over the city were coming to both clinics," said Gowdey of the demographic criticisms lodged against Community Dental. "And besides, what track record does UCSF have? There's not a single shred of evidence that UCSF could do any better. In fact the opposite is true because it's not located in a community of high incidence of HIV."

What it seems to come down to is a financial bargain as far as how CARE money is spent: the DPH panel decided to split the annualized $600,000 in funding between two groups, with two-thirds going to UCSF, and one-third going to DPH's Tom Waddell Clinic so that Tenderloin needs can be addressed. UCSF, noted the summary report, estimated that many more clients would walk through its doors than Community Dental.

But while Gowdey acknowledged that UCSF may look like a better financial deal on paper than Community Dental, he said that what seems less expensive will come at great cost to Community Dental patients.

"How can an office of real dentists compete financially when UCSF has dental students working for free, who just need to get patients in the door?" said Gowdey. "The whole reason to establish the neighborhood clinics in the first place was to provide an alternative to the slow and tedious process of receiving dental care from dental students. Many people with HIV and AIDS cannot tolerate long and exhausting procedures at dental schools. A procedure that takes Community Dental a few months can take schools up to a year."

"I take issue with the process by which UCSF was awarded this contract. If somebody is better suited to do a service than me, then I'll bow out, but that's not the case here. They want to set up decentralized dental care, and only centralized dental programs applied. We were the only applicant that can fulfill the CARE Council's mandates and the criteria set in the requests for proposals."

UCSF officials declined to comment.

A grievance procedure is under way, and patients of Community Dental have reportedly filed letters of objection with DPH and the mayor, but as it stands, Community Dental is winding down and preparing for its final weeks.
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