July 26–It began with a toothache. Tori Pence, 23, could feel the hole that had suddenly developed on her tooth, and she couldn’t stand either hot or cold food. The bespectacled girl with electric-blue hair had worked a string of odd jobs and hadn’t seen a dentist for at least five years.

When she finally got in to see one, she needed a root canal. And fillings for 15 cavities.

“Dentally speaking, I am healthy now,” says Pence, who lives in Lansdowne and has been making monthly visits to the University of Pennsylvania’s dental clinic for almost a year. “But I still have seven more [cavities] to go.”

Pence is one of the estimated 132 million people in the United States without any sort of dental insurance. It’s an endemic problem among the unemployed, the poorly paid, and those without medical insurance.

While the national health-care act passed in spring will increase the number of people eligible for medical insurance, its effects on dental will be mixed.

The law increases coverage for children, and will eventually cover more adults under Medicaid, the joint state-federal health plan for the poor. But adult dental services are often hard to find: Less than one-third of dentists in Pennsylvania and New Jersey participate in Medicaid.

Many people don’t see the value in preventive dental care — or they dread it — and postpone routine checkups. That is, until it becomes too painful to chew or a front tooth is chipped.

In Philadelphia, geriatric dentist Ann Slaughter says many elderly patients she has examined at inner-city senior centers haven’t seen a dentist for up to 15 years.

But “oral health is intimately connected to overall health,” she says.

Periodontal disease can cause or worsen heart conditions, strokes, and respiratory illness.

It can be perilous for diabetics. Germs from gum disease can make them more prone to complications, says Slaughter, an assistant professor at the University of Pennsylvania School of Dental Medicine and a member of the city Board of Health.

More than 200 diseases of the mouth can also cause problems elsewhere in the body. The plaque on teeth can travel into the blood and contribute to hardened arteries, a risk for heart attack.

In 2000, Surgeon General David Satcher called dental and oral diseases a “silent epidemic” facing the nation.

“We’re in 2010, and we haven’t made many advances,” Slaughter notes. “That’s the sad part.”

One problem is the many gaps in dental insurance, which unlike medical insurance, was never intended to completely cover anything.

For those without insurance, the median price for a root canal in Philadelphia is $862, according to a survey that dentists use to price procedures. A crown can cost as much as $1,200.

And while 172 million Americans under 65 have private health insurance, just 45 million of them have any sort of dental plan, according to the National Center for Health Statistics.

In Pennsylvania, 40 percent of the entire population of adults and children lacks dental insurance, according to the Pennsylvania Dental Association.

Medicare has substantial holes as well. It covers health care for virtually all seniors and some younger people with permanent disabilities. But it doesn’t pay for routine dental care.

When people turn 65, says Slaughter, “those with disposable incomes pay out of pocket or they keep their dental insurance.”

Medicare does cover dental procedures that are connected to a larger medical issue. A surgeon won’t perform an open-heart operation on a patient who has a mouth abscess, for example, until a dentist has treated the problem.

Medicaid poses its own challenges. There are 508,000 recipients in Philadelphia, but many of the adults aren’t eligible for dental because they aren’t permanently disabled or fail to meet other criteria.

Those who are eligible can have a hard time finding a dentist.

“Just because you have insurance doesn’t mean you have access,” says Laval Miller-Wilson, the executive director of the Pennsylvania Health Law Project.

Pennsylvania has some of the lowest reimbursement rates in the country, according to a recent report by the Pew Center on the States. Pennsylvania’s Medicaid program reimbursed dentists 53 percent of what they customarily charge. The national average for Medicaid is 60.5 percent.

New Jersey had among the nation’s lowest reimbursement rates until recently, but now pays 103 percent of the customary fee, according to the Pew Center, which nevertheless gave the state an F on its dental report card due to other limitations of coverage for the poor. (Pennsylvania also got an F.)

Miller-Wilson says some dentists’ aversion to Medicaid is about more than money. The paperwork is cumbersome. And broken and late appointments are common among the poor.

Instead of accepting Medicaid, “many dentists say they would rather treat patients during free clinics or pro bono,” says Rob Pugliese, spokesman for the Pennsylvania Dental Association.

Lack of increased funding for Medicaid dental services is a major reason the American Dental Association opposed the health-care bill.

In 2014, when the new law enables millions more Americans to join Medicaid, many advocates wonder if there will be longer lines to see dentists as well as doctors.

“The health-coverage bill is going to exacerbate the current supply problem,” says Miller-Wilson, adding that the state of dental care now may foreshadow what is to come.

Many advocates point to the 2007 death of 12-year-old Deamonte Driver in Prince George’s County, Md., as the impetus for Congress to make sure that dental was included in the basic benefits package for children on Medicaid.

Driver died from a bacterial infection caused by an abscess in his mouth. His mother had been unable to find a dentist who would accept his Medicaid.

Philadelphia’s Slaughter wonders whether “it will take another catastrophe like Driver’s to get policy makers’ attention.”

Even if coverage is broadened, other issues remain.

Pence, the woman with 15 cavities, is in many ways typical of her generation. She was cut off from her father’s health and dental insurance when she turned 18. She ignored her teeth for several years as she worked part time.

Last September, the pain became overwhelming. Following her aunt’s advice, she went to Penn’s dental clinic to get treated at a reduced rate.

In March, she started working a full-time job with benefits. She can now afford yet another fix: the skin graft she needs at the base of her bottom front teeth. Her tongue piercing had worn down the gums so much that “you can see the roots of my teeth,” Pence says.

She has since removed the piercing. She promises to see her dentist regularly in the future.

Reduced-Fee Dental Clinics in Region

Donated Dental Services

717-238-8721

www.nfdh.org (Locations throughout Southeastern Pennsylvania)

Philadelphia

City health centers

Seven of the clinics offer dental services. Call 215-686-1776 for locations, or go to www.phila.gov/health/Services/Serv_DentalCare.html

(Medicaid accepted)

Afton Family Dental PC

215-462-6229

Fairmount Primary Care

Center

215-684-5349

www.dvch.org

Maria de los Santos Health Center

215-291-2509

www.dvch.org

(Medicaid accepted)

Frankford Avenue/Hunting Park/Snyder Dental/Wilson Park Medical Centers

215-229-1390

www.gphainc.org

(Medicaid accepted)

Vaux Family Health Center

215-236-8289

www.qchc.org

(Medicaid accepted)

QCHC Family Health Center

215-227-0300

www.qchc.org

(Medicaid accepted)

University of Pennsylvania School of Dental Medicine Dental Clinic

215-898-8965

www.dental.upenn.edu

(Medicaid accepted)

Ronald McDonald Care Mobile

215-427-8877

(Free for qualified children; Medicaid accepted)

Clinic of Temple University Kornberg School of Dentistry

215-707-2900

www.temple.edu/dentistry

(Senior citizen discount; Medicaid accepted)

Bucks County

Bucks County Health Improvement Project

1-800-347-6803 (Free for qualified children)

Ann Silverman Community Health Clinic

215-345-2410

HealthLink Medical Center

215-364-4247

www.healthlinkmedical.org

Chester County

Community Volunteers in Medicine

610-836-5990

www.cvim.org

(Free)

The Children’s Dental Clinic

610-240-1213

Delaware County

ChesPenn Health Services

610-874-6231; 610-497-2900

Montgomery County

Manor Dental Health Center

215-887-7617

www.manor.edu

Greater North Penn Dental Initiative

1-877-466-7764

(Medicaid accepted)

Norristown Regional Health

Center

610-278-7787

www.dvch.org

(Medicaid accepted)

The Abram and Goldie Cohen Dental Programs Center

610-526-6015

www.harcum.edu

(Medicaid accepted)

Camden County

Camden County College, Dental Hygiene Clinic

856-374-4930

CamCare Health Corporation — East

856-635-0307

(Medicaid accepted)

CamCare Health Corporation — Gateway Center

856-963-8768

(Medicaid accepted)

CamCare Health Corporation — Clementon

856-627-7701

(Medicaid accepted)

UMDNJ — Somerdale

856-566-6969

(Medicaid accepted)

Virtua Dental Health Center

856-246-3545

(Medicaid accepted)

SOURCES: Pennsylvania and New Jersey dental associations

Contact staff writer Brooke Minters at 215-854-2244 or bminters@phillynews.com.

Credit: The Philadelphia Inquirer

Tuesday, I wrote about saving money on dental costs by checking out one of five schools for dental assistants and hygienists as well as the University of Minnesota School of Dentistry (www.startribune.com/dollars). The savings on exams, cleaning, scaling, sealants and whiteners at the hygienist/assistant schools are significant — about 75 percent compared with the cost to see a dentist in private practice. In addition to the Twin Cities schools mentioned, there are dental hygienist programs on campus at Lake Superior College in Duluth (1-218-733-5939), Minnesota State Community and Technical College in Moorhead (1-218-299-6560), Minnesota State University in Mankato (1-507-389-2147), Rochester Community and Technical College in Rochester (1-507-280-3169) and St. Cloud Technical College in St. Cloud (1-320-308-5919).

Not everyone has the extra time it takes to visit a dental school. Here are more options to save on your dental bill:

Online coupons

Some dentists do marketing and advertising to attract patients. Check the Valpak coupons that come in a blue envelope by mail or at www.valpak.com under “health.” Last week four Twin Cities dentists offered deals, including an exam for about $75. Moneymailer.com had a $99 offer for X-rays, evaluation and cleaning under the “professional” category. Groupon.com recently had a cleaning and exam special for $59.

Low-cost dentists

Go to tinyurl.com/y8un6y2 for a list of some dental clinics in Minnesota that provide services to patients on public care programs, or that offer services at reduced cost. Services, hours and costs at the clinics vary. If you’re unemployed or in financial difficulty, you also can check with your regular dentist about lowering fees before calling the clinics, which might require a longer wait. Call 1-800-950-3368 for a clinic near you if you don’t have a computer.

Insurance

Whether you are considering insurance privately or through an employer, ask these questions: Is there a waiting period? (Some plans require you to be on the plan for a year before major work can be done.) What percentage do you pay for a specific procedure? (The policy could cover as little as 50 or as much as 100 percent of the cost of the procedure.) What’s the maximum coverage in a year? (Many plans have a limit, such as $1,000 per calendar year.) What’s the deductible? (You might be responsible for the first $250 or so.) What’s excluded? (Orthodontia often is not covered.)

Dental plans

An alternative to insurance, dental plans offer members discounted fees at a wide network of dentists, but few of us have heard of them. At www.dentalplans.com (1-888-632-5353), an individual pays about $105 per year or $160 for a family plan. Sample discounted prices, according the site, include $25 for a routine checkup (usual fee $56), four bite-wing X-rays $33 (usual fee $70), a white, one-surface filling $75 (usual fee $175) and a crown $624 (usual fee $1,190). Check to make sure your dentist participates in the plan. There is a 30-day cancellation policy and no waiting periods, deductibles or maximums. Orthodontia is included in some of the plans, including those underwritten by Cigna and Aetna. When I called earlier this week and said that I wasn’t quite ready to join, I was offered a 20 percent discount if I signed up immediately.

-Monongalia County School’s Board of Education has tabled changes to the dental insurance plan until more research can be done.

The BOE made its decision Tuesday, after it received more information about possible changes.

The members learned about joining a Preferred Provider Organization, updating the policy and changing to a usual and customary rate.

But BOE President Nancy Walker said they wanted to have the whole policy reviewed, instead of making changes over of several months.

“I’d prefer to do this once and not come back,” she said.

Walker said she would like to see the exact plan before making any changes. She has also spoken to her dentist and several procedures the plan covers are outdated.

Walker said she wants board members to look at what exactly they are covering.

The discussion comes on the heels of a board vote to reverse changes made to the dental plan.

On Sept. 22, the board approved changing the way dentists made charges.

The vote was not on the agenda and was brought up during discussion of increasing benefits in the employees’ vision plan.

Employees receive a $1,500 allotment for their dental coverage, Superintendent Frank Devono said.

For example, if an employee receives a teeth cleaning that costs $100, he or she would have $1,400 to pay for other procedures.

Amber Zackery, co-president of the Monongalia County Education Association, said she was happy the board said it made a mistake and rescinded the vote.

She thought that vote overshadowed the good news about the increase in optical benefits approved at the same meeting.

The organization is going to try to work with the administration to determine the best benefit plan for its employees, Zackery said.

She said she doesn’t oppose changes to any insurance package, as long as it benefits the workers.

The board was informed of two possible changes it could make. The first was switching to a Preferred Provider Organization (PPO).

With the switch, there would be no coverage changes and enrollees could visit any doctor, said Robyn Dilley, of American Benefits, administrator for the board’s policy. But employees who visit a dentist in the organization would receive a discount on the procedure’s costs.

The board decided against joining any organization without more research.

It also learned about usual and customary rate. Dentists are surveyed about a procedure’s cost and a maximum amount set that the insurance would pay for a procedure.

The patient would pick up any costs over the rate.

Of the more than 10,000 preventive care claims in the past year, Dilley said, more than 3,000 would have been over the rate.

But nearly 2,400 were $10 or less over the rate. She said many dentists don’t bill that small of an amount because it isn’t worth the time to recoup the money.

Devono said if they do make changes, board members would like to use the savings to improve the dental plan, either by increasing an employee’s allotment or by offering coverage on different procedures.

Board member Barbara Parsons said she would like them to look at their insurance policies every year to see if they need updating or changing.

“This isn’t something you can do overnight,” she said.

Credit: The Dominion Post, Morgantown, W.Va.

It has been a busy time for education recently. The Renal Care Skills set for ENs I spoke about in my August column has been endorsed by the National Quality Council and is now available through the Community Services and Health Industry Skills Council (CSHISC). You can find out who will be delivering it by contacting your State/Territory Training Authority.

I was recently invited to participate on another Industry reference group for the CSHISC to explore the impact of oral health on the Australian population. Like many of you, I’m sure, I don’t really like dentists very much but there I was in a room filled with dentists and dental hygienists discussing the state of Australians teeth and mouths. I found myself subconsciously doing a check. When was the last time I went to the dentist; do my teeth look ok; and should I excuse myself and give them another clean?

Seriously though, it was a very interesting group that led to quite an informative discussion around oral health and its impact on Australians from young children through to the elderly population. Did you know that dental caries are the second most costly diet-related disease in Australia, comparable to the economic impact of heart disease and diabetes? As nurses we know that oral diseases cause a substantial amount of pain and can impact heavily on a person’s quality of life.

Nurses and midwives are being asked to be part of an alternative workforce to assist the oral health care workforce to address an increasing demand for oral health care services as we care for people from birth to death. All nurses, including child and maternal health nurses, midwives, community health nurses, nurse practioners, mental health nurses and Al Ns already play a very important role in the care of Australians oral health and through this project it is anticipated we will have a much bigger impact on our patients’ oral health. I will keep you posted on the progress of this important project.

Just a quick reminder that our new ‘Asthma Management’ tutorial is FREE to members for the month of November and also please keep the feedback coming. I do love hearing from you all.

Financial services information and intelligence provider BAI has put a finger on the pulse of the banking industry and its findings come today in the form of a new economic measure – the BAI & Finacle Banking Confidence Index(TM). The new index, sponsored by NewGround, looks at the extent to which upheaval in the financial services industry in the last six months has affected consumers’ views across five areas: Financial Stress and the Economy; Access to Credit; Managing Personal Finances; Consumer Trust; and, Fees & Disclosure. The index also projects how consumers expect to feel about these areas in six month’s time. To develop its new biannual index, BAI conducted 2,501 interviews across a representative sample of U.S. households in late August 2009 (see also <http://www.newsrx.com/library/topics/BAI.html> BAI).

“This is the first index we know of to focus exclusively on consumer sentiments vis-a-vis retail banking,” said Debbie Bianucci, president and CEO of BAI. “We designed this research with a rigorous methodology, so the index will have maximum value to executives who are focused on measuring consumer trust and confidence in retail banking.”

“In today’s fast-changing scenario, consumer opinion counts more than ever before and technology has made the consumer highly empowered,” said Haragopal Mangipudi, global head – Finacle, Infosys Technologies Ltd. “Presented with diverse and ever-dynamic consumer segments, banks need to anticipate changing requirements and fine-tune business strategy. Finacle with BAI has launched this index for banks to gain insight into consumer trends for innovation on future business strategy and differentiated product offerings.” Among the index’s findings were the following: Financial Stress and the Economy: One-third of consumers feel their financial situation has deteriorated in recent months, but few expect things to grow worse then now. When asked if they thought the current overall employment situation in the country was better, worse or the same as compared to six months ago, 73 percent of respondents said it was worse, 21 percent said things had remained the same and 5 percent felt the situation was better. But 40 percent felt the overall economic condition of the country would be better in six months. When asked which items among a list of behaviors respondents had altered to address their financial concerns, 71 percent said they had trimmed spending on entertainment, 60 percent had changed eating habits to save money, and 34 percent had postponed medical or dental care. Access to Credit: Along with mortgage-related products, most consumers find accessing credit a challenge. Compared to six months ago, 31 percent of respondents feel access to mortgages is worse; 5 percent say it is better, and the remainder saw no change. Those surveyed showed optimism when asked if they thought access to mortgages would be better, stay the same or become worse in six months, with 12 percent saying things would be better and 15 percent saying it would be worse. When asked to look ahead six months and say how likely they were to take out a loan to purchase a car, buy a home, or open a line of credit, respondents who were not likely to do so tallied 71 percent, 82 percent and 80 percent, respectively. Managing Personal Finances: Consumers basically trust their banks, but are less certain about their bankers’ ability to truly understand what consumers are trying to accomplish financially. While 65 percent of consumers surveyed say they trust their primary financial institution and another 81 percent feel their bank will still be in business a year from now, only 35 percent of respondents felt their primary financial institution was concerned about their financial well-being. One out of three respondents said their primary financial institution understood their financial goals. When asked to look ahead six months and project whether they would feel differently about their primary financial institution in these areas, the numbers were largely unchanged.

“In spite of everything that’s happened to our economy, most people still trust their primary bank. And people surveyed said they have some willingness to take on more risk, but they’re concerned about their ability to make the right decisions,” remarked Ajay Nagarkatte, managing director, BAI Research. “For bankers, this is an opportunity to take a fresh approach to how they work with their customers, and develop an array of new products and services that will go further to help people with their financial decision-making.” Consumer Trust: The level of trust consumers expressed in their financial services institutions was largely based on how familiar they were with the organization. Fifty-three percent of respondents who were customers of large national banks said they trust their bank. The same measure rose to 63 percent for clients of regional banks, 82 percent for customers of community banks, and 83 percent for those banking at credit unions. Customers of community banks and credit unions were likely to recommend those institutions by a measure of 72 percent and 76 percent, respectively. Fees & Disclosure: Less than a third of respondents find overdraft fees fair or reasonable. When it comes to fees and disclosures, consumers appear to understand to some extent why banks charge overdraft fees. But only 30 percent of those surveyed believed banks needed to collect such fees to manage overdrawn accounts. Only half of respondents felt the disclosures that financial institutions give for accounts, terms, rates, and fees were easy to understand.

“Recent changes introduced by some of the nation’s large banks are a good initial step to address consumer concerns. But simplified disclosures and clarity around when fees are assessed will continue to be a central theme, unless meaningful, long-term changes are made,” added Nagarkatte. About the Index and Survey BAI and Finacle created this new index, in part, to help bankers and industry-watchers understand the level of trust consumers have in the U.S. banking system. Along with that, the index assesses potential changes in consumer behavior, tracks consumers’ attitudes about their financial service providers, and offers a view behind the trends affecting the financial industry.

The Highlands County Health Department began offering free dental care to uninsured pregnant women last Wednesday and its offices are already booked for the next two weeks.

“We’ve had a tremendous response from women learning about it through their OBGYN’s,” said Dr. Gerald Pyser, dental executive director for Highlands County Health Department.

Uninsured pregnant women and those receiving Medicaid are now eligible for free dental care at the health department’s dental office in Sebring.

The dental program, New Maty’s Dental Program, is the first to be offered to pregnant women in the county. According to Florida Department of Health’s 2008 statistics the program hopes to reach Highlands County’s 150 pregnant teens and 565 single mothers.

“The county has a high teen pregnancy rate and that’s really what’s driving the wheel,” Pyser said.

The program will offer free preventive and restorative care for pregnant women through out their pregnancy.

The health department’s program also seeks to educate expecting mothers on preventive dental care for their infants.

Pyser said pre-dental care leads to healthier mothers and infants.

“Treatment and prevention of dental and gum disease in pregnancy has a very positive effect on preventing preterm labor and low birth weight infants,” he said.

The department hired Dr. Joel Shapses, a dentist from Collier County, to treat patients for this program once a week on Wednesday by appointment.

Pyser said the program is permanent and based on the needs of the county.

“We hope to expand the program,” he said.

For more information on New Maty’s Dental Program, call 382-7257.

As New Orleans’s governmental services collapsed after Hurricane Katrina in 2005, Norman Francis, president of Xavier University of Louisiana–the “Black Notre Dame of the South”–organized an armada of boats and a convoy of buses to evacuate students and staffers stranded at the flooded campus.

Even more remarkable: Within weeks, Francis ordered up his own storm–of repairs, fundraising, and morale-boosting for the 4,000-student campus. By January 2006, the nation’s most successful training ground for African-American physicians, scientists, and pharmacists was back.

In 2007, Xavier graduated 165 African-American math and science majors. Ohio State, high and dry with more than 50,000 students, graduated 27; MIT, 12. But Xavier is no degree mill. It places a disproportionate number of its grads into medical and dental schools. Among the alumni: Alexis Herman, secretary of labor under President Clinton, and Regina Benjamin, winner of a “MacArthur genius grant,” President Obama’s nominee to be surgeon general, and an America’s Best Leaders pick in 2008.

Reopening so quickly “was quite a feat. It was dangerous just trying to get back into New Orleans through October [2005],” recalls Leonard Weather, a Louisiana physician, former Xavier lecturer, and president-elect of the National Medical Association, a group of African-American doctors. Francis “has done an incredible job,” Weather says.

The son of a barber, Francis worked his way through Xavier and desegregated nearby Loyola Law School. He traveled the South as a civil rights lawyer. As a Xavier dean in the 1960s, he ignored bomb threats to house Freedom Riders in the school’s dorms. In 1968, just 36, Francis took the helm at Xavier and quietly built the science program into what he complains is one of the world’s “best-kept secrets.”

There is no fairy-tale post-hurricane ending, though. Xavier struggles with Katrina damage, the recession, and longtime societal problems. Enrollment hasn’t recovered to pre-Katrina levels. About 90 percent of Xavier students need financial aid. But Francis, a 2006 recipient of the Medal of Freedom, has raised millions to fund scholarships and improvements. At 78, he is bubbling with plans to improve Xavier’s pharmacy and business programs, science summer schools for youngsters, and teacher training programs. With Obama funneling billions of dollars into education, Francis believes that “Xavier is sitting on the cusp of an opportunity it never had before.”

Maybe the secret is finally getting out.

When Dr. Jonathan Crane prescribes a certain medication for athlete’s foot he also orders an expensive battery of liver tests. It’s a precaution, the dermatologist says, and is considered the standard of care. The tests are also completely unnecessary, Crane says, but he orders them anyway because the risk of a lawsuit makes it necessary.

It’s an example of “defensive medicine,” and a result of too many malpractice suits. So when people talk about changing health care they need to also consider tort reform, he said.

Thursday night, Crane opened up his office, Atlantic Dermatology in Wilmington, to several local politicians and an audience of a few dozen people to discuss possible health care changes.

New Hanover County Commissioner Jason Thompson, state Rep. Daniel McComas,, R-Wilmington, and Will Breazeale, a Republican who plans to run as for the U.S. House of Representatives in 2010 attended.

The point, Crane said, was to discuss alternatives to current health care reforms and also encourage people to go online and study the proposed reforms.

“We don’t need to go in and wreck everything,” McComas said. “This is too complicated a problem, we need to take it step by step.”

Thompson said New Hanover County spends millions of dollars each year on health care. They pay for everything from transportation costs for taking Medicaid patients to doctors’ offices, and dental care for uninsured children, he said.

On the national level, Breazeale proposed a Fair Health plan in which health insurance companies would compete for government contracts to cover the uninsured. The costs would be through a sales tax on people without insurance.

Crane said tort reform and changes to the Food and Drug Administration are needed to drive down medical and drug costs.

Several doctors who attended said they worry some changes aren’t part of current proposals.

Dr. Victor Abraham, a urologist, said giving tax breaks to doctors who treat the uninsured might be a good start.

Dr. Hormoze A. Goudarzi, a local surgeon who favors a basic Medicare-type plan for everyone, said politicians need to sit down with insurance companies and come up with ideas.

“This is everybody’s problem,” he said. “This system will collapse unless we do something about it.”

Dentalplans coupon

Some Dale County officials are hoping a medical contracting service will help curb medical expenses of inmates in the Dale County Jail.

While Dale County commissioners had yet to vote to contract out the jail’s medical services from the $70,000 budget line the upcoming fiscal year, some commissioners said they would at least consider the change for next fiscal year in order to keep down expenses.

Dale County Sheriff Wally Olson said an estimated $76,000 had been spent on the medical care of inmates this year.

“That money does not even include the salary or the overtime of the deputies who transport the inmates back and forth or who sit at the hospitals and the doctors’ offices with the inmates,” Olson said.

“A contract service would keep some of those expenses at bay and would free up the deputies from having to make those runs as much.”

Olson said he already presented one proposal to the commission that is an estimated $80,000 and will include an on-staff doctor, nurse, dental plan and a portable x-ray machine.

Dale County Commissioner Gerald Harden said longterm savings would be what determined whether to have contract service.

“You have to think about every angle. Right now we haven’t gotten that far,” he said.

Based on the theory of transformative learning (Mezirow, 1980) and critical pedagogy (Freire, 1980), mixed-methods research (Tashakkori & Teddlie, 1998) of a hospital workers’ union and training organization addressed the impact of a custom-designed, group-focused, results-driven professional development model with 130 participants. Employees across many job titles participated. Findings reveal substantial content learning, along with the development of empowerment and voice. The purpose of the research was to determine the ways and the extent that worker voice, satisfaction, attitude, communication, and problem solving improved as workers and managers put into practice knowledge and skills learned through the training (Winchester, 2003). The scope of results includes efficiency and skill improvements and qualitative changes intersecting professional and personal realms.