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Reformed Dental Care Will Have Ohio Prisoners Smiling

The Ohio Department of Rehabilitation and Correction (ODRC) will hire dozens of dental health care providers, revise policies and procedures governing prisoner dental care, and implement oral health care education programs as part of a settlement agreed to in a larger class action lawsuit that alleged constitutionally inadequate health care in the Ohio prison system.

State prisoners Rodney Fussell, Gary Roberts, and James Love sued the ODRC in October 2003 alleging constitutionally inadequate health care.
In January 2004 the U.S. District Court for the Southern District of Ohio certified the case as a class action and appointed attorneys Alphonse A. Gerhardstein and David Singleton (an attorney with the Prison Reform Advocacy Center--now known as the Ohio Justice and Policy Center), to represent the prisoners.

In November 2005, after a jointly approved fact finding process undertaken by various prison health care experts, the ODRC agreed to implement reforms in more than 30 areas related to prisoner medical and dental care. Some of the more notable aspects included adding an additional 296 licensed medical personnel and 21 physicians; revising policies and procedures related to prisoner medical and dental care, along with training programs to keep staff informed of the new policies and procedures; implementing quality control measures; revising copay procedures to ensure that prisoners are not unduly deterred from seeking medical attention; and continuing oversight to ensure compliance with the settlement agreement.

The agreement on prisoner dental care is the latest iteration of the larger lawsuit. Agreed to by the parties on January 9, 2007, it contains many of the same provisions. This is important because, as much as prisons skimp on prisoner health care, they tend to be even more parsimonious with dental services. Many state prison systems now provide only the most basic dental care, simply pulling teeth when cavities or infections develop and refusing to provide false teeth or partials, even when the lack of teeth interferes with chewing or other daily activities.

In the area of dental staffing, the ODRC agreed to employ at least one full time, licensed dentist for every 1,200 prisoners. The prison system will also hire 24 full time, licensed dental hygienists and one full time dental assistant for each dentist.

Incoming prisoners will also be screened for dental problems at predetermined intervals and at preset levels. Within seven days of arrival in the ODRC prisoners will be examined by an appropriately trained midlevel practitioner or above for dental problems requiring immediate care. Then, within 90 days, each prisoner will be seen by a dentist for a ?mandatory initial dental exam.? This exam will include full x-rays, an oral inspection consistent with the current standard of care, and meaningful oral health education and self-instruction.

In addition, all prisoners will be entitled to annual routine dental exams, cleaning, and continuing oral health education.

Importantly, conditions that hinder chewing, affect sleeping, or interfere with daily activities will be considered urgent, something treated as minor, if treated at all, in many prison systems.

The ODRC will also take measures to ensure that the standard for dental care is met within the prison system. These measures will include a Dental Review Board charged with reviewing all cases that fall outside the guidelines established in the ODRC?s revised policies and procedures. Moreover, a quality assurance program will be instituted to monitor compliance with dental policy and procedure, equipment use and maintenance, the quality of dental x-rays, prisoner satisfaction with dental care, and various other areas of performance relating to dental care.

Of special note, the agreement includes a provision requiring the ODRC to implement a peer review program to assess the quality of care provided by prison dentists. Under this program each prison dentist will be assessed at a minimum of every two years through a detailed record review. Dentists with provisional licenses will be reviewed within 90 days after they start providing clinical services. Dentists with issues at the time of their review will be reviewed again within 90 days.

As a final effort to improve the quality of care, the ODRC will implement an electronic medical and dental record system. The ODRC is required to launch an initial pilot program of the system by December 31, 2007.

It should be recognized that the agreement in this case came about through the findings recommendations of a "Dental Investigation Team" ("Medical Investigation Team" in the overall suit), a mutually agreed upon team of experts tasked with uncovering and reporting deficiencies within the prison health care system, rather than undertaking the more costly and contentious process of discovery. Pursuing this route resulted in a significant savings to taxpayers.

The agreement includes reimbursement for attorneys' fees and costs accrued during litigation and for continued oversight of the agreement. See: Fussell v. Wilkinson, USDC SD OH, Case No. C-1-03-704 (SSB).

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Related legal case

Fussell v. Wilkinson

The complaint and settlement are available in the brief bank.