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Nevertheless, according to Ames, the reason the clinic shut down in the first place had nothing to do with HIV. It was purely a monetary decision, says Rick Ames, head of all county dental clinics. Last winter the worst budget crunch in decades forced the Broward County Health Department to strip its services to the bone. (Although the CDTC is by jurisdiction part of the North Broward Hospital District, its dental clinic has been managed by the health department, which provided its dentist and supervised its operations.)
Suddenly the department found its budget for dental services cut by more than 20 percent, from $918,000 to $722,000. As a result Ames was forced to cancel many part-time contracts and consolidate what staff still remained. Ames decided he had no choice but to transfer Barnes out of the CDTC clinic and into the health department's Northwest Health Center.
That left the CDTC clinic without a dentist and 19-year-old Jenelle James with a sore jaw. Last spring James felt a sharp pain in the side of her mouth and realized that the loose filling she'd been ignoring for some time had finally sprung out. Since she had already been treated several times by Barnes, she naturally called the CDTC clinic to set up an appointment. Instead she learned that "all of a sudden, he was just gone." James, like Hubbard, is HIV-positive and an unmarried mother of two. She doesn't have many other options, and she's not alone.
In a survey completed earlier this year, dental services were listed as the third-most-needed service among the HIV-positive population of Broward County, according to the Broward County HIV Health Services Planning Council. Recognizing this need the council has directed more than $400,000 of the state's Ryan White funds to the county health department for the explicit purpose of providing dental services, says Gary Morey, council chair.
Meanwhile Ames says he is working with the CDTC on several fronts to try to find enough extra cash to allow the dental clinic to get back in business. So far, though, no amount of number-crunching has been able to solve the basic problem: not enough money to reopen the clinic and meet the demand. "Our northwest clinic is double-booked up solid two months ahead," he says. One possible solution, says Schevis, would be to staff the clinic at least in part with instructors and graduate students from local dental colleges.
For the time being, though, the CDTC clinic remains a strange and disorienting island of emptiness in the center of such a large and sprawling health complex, one devoted to healing children of a multitude of medical problems -- except those having to do with teeth.