In 2006, the Dental Program entered into a Stipulated Agreement in the Perez v. Cate class action lawsuit. The Program has made great strides over the last four years to come into compliance with the Stipulated Agreement. Our goal is to be in compliance with and meet the court-ordered mandates per Perez. Institutions use the Dental Audit Instrument, developed by the Perez Court Experts and approved by the parties, to evaluate whether their local dental program meets agreed-upon standards and to identify areas where improvement may be necessary. The Dental Program reviews audit results to identify institutions which may require assistance or may offer best practices and to determine which dental program areas may be problematic, requiring support or state intervention.
The Court Experts’ Audit Instrument is composed of 43 questions, separated into three domains: Clinical Process, Quality of Care, and Patient Safety. The Dental Program uses this tool to conduct internal program reviews. When an institution achieves a passing score in all domains on the internal review, the Dental Program notifies the Perez Court Experts that the institution is ready for a Court Expert review. The Court Experts have 30 days to perform an audit, using the Audit Instrument. If the institution passes the Court Expert audit, it is no longer subject to tours by the Plaintiff’s Counsel or the Court Experts.
In 2011, the Dental Program successfully passed 19 Perez Court Expert audits. The Dental Program continues to work diligently to prepare for the remaining 19 audits by the end of 2012. Earlier construction plans called for the building of new clinics with additional dental chairs while the Dental Improvement Project (DIP) address infection control and ergonomic issues. The need for additional chairs and space for treatment has been addressed through local measures such as alternative work shifts and staffing third watch. This approach has allowed the dental program to realize millions of dollars in savings while still meeting the needs of the inmate-patients. Originally there was a dental construction plan that had new clinics with new dental chairs built at the cost of $1.2 billion. With the anticipated drop in population from Realignment, that plan would now be outdated, and unnecessary construction would occur. With our more prudent approach, the DIP is still a necessary and viable plan as it addresses infection control and ergonomic issues with a total cost hovering around $15 million.
The Dental Program has achieved tremendous successes over the last few years while also realizing great savings. As mentioned earlier, the modified construction plan has reduced costs by over a billion dollars. Several staffing changes have been made in the dental program that have improved effectiveness and efficiently of the program, and these changes have also saved the state money. In February 2010, the Chief Dentist positions were eliminated at the institutional level and were replaced by the Health Program Manger III (HPM III). This change allowed for the administrative duties of the dental program to be taken care of by an administrator while the clinical duties are still overseen by the Supervising Dentist (SD). In addition, in January 2011, dental hygienists were introduced to the dental program at a ratio of 1 dental hygienist to 2000 inmate-patients. With the introduction of the hygienists, the dentist ratio was changed from 1 dentist to 515 inmate-patients to 1 dentist to 600 inmate-patients. The above changes have resulted in $10 million on-going annual savings for the State of California. As each of these changes has occurred, the Dental Program has noted improved services to the inmate-patients at a reduced cost to the State.
We look forward to continuing to work collectively and proactively to reach our goals.