Dental controversy

Wednesday, Dec. 1, 1999 | 11:45 a.m.

Dental Residency

The Dental Residency Program, since its opening July 1, has done $193,000 worth of work on the teeth of Southern Nevadans.

$35,000 worth of work at a rate of roughly $100 per extraction.

$31,000 worth of work at a rate of roughly $400 each.

$29,000 worth of work at a rate of roughly $65 for a simple filling.

$10,000 worth of work at a rate of $600 to $700 each.

$6,000 to $10,000 worth of work at a rate of between $3,000 and $5,000 each.

Did two of the three members of the state's fledgling dental residency program quit because they thought it was hopeless or did they fail to give it enough time before pulling out?

The university Board of Regents is sure to ponder those questions Thursday in Reno when State Sen. Ray Rawson, a Las Vegas dentist who is director of dental programs for the University and Community College System, will address the program's mounting woes and trumpet its highlights.

Rawson says he is determined that the residency program and the planned UNLV school of dentistry -- set to open in 2001 -- will overcome early setbacks and thrive. Also in 2001 the residency program is scheduled to shift from the University of Nevada School of Medicine to UNLV.

The dental residents, who were picked from a nationwide search of 200 of the brightest dental school graduates, say they were made promises that have not been kept.

One promise was that they would receive unrestricted licenses without taking the state test after concluding their two-year residencies. They later learned that, like every other dentist in the state, they will have to pony up $300 and pass the three-day exam.

Dr. Charles Duke Aldridge left the program Sept. 28, less than three months after he came on board. Dr. Tony Ippolito is still in the program but has said he will leave in January. Dr. Brent Bauer has decided to stay to see if things improve.

"Going there was the worst decision of my life," said 39-year-old Aldridge, who was raised in Las Vegas, graduated from Las Vegas High School and was a development executive with Hilton Hotels before going to dentistry school in Texas.

"Leaving the residency program was the best decision I ever made. I knew when to cut my losses and get out of Dodge."

Aldridge, a father of two who still hasn't sold the Las Vegas home he and his wife bought when he took the residency here, today works as a licensed dentist in a private practice in central Oregon, from where he was interviewed Tuesday by phone.

Aldridge "left on a snap decision," Rawson said. "Three months does not seem like he gave it a fair chance.

"I feel this is a non-story. We lose two to three students a year in the medical residency program and the news media never writes a word about that. Students quit school every day after deciding it was not what they wanted."

Ippolito, 30, says he decided to stick it out a little longer because he could not afford to quit the $40,000-a-year residency job. He also felt he needed more time to sell the Las Vegas home he and his wife bought after he accepted the residency post.

Ippolito is licensed to practice dentistry in New York and is eligible to apply for licensing in 13 other Northeastern states. He plans to return to the East Coast early next year to get a job as a dentist.

Ippolito and Aldridge say that during the recruitment process they were told a lot of things by the program's first director Dr. George Seng -- a man they say had a sterling reputation nationwide -- that have not materialized.

Seng died of lung cancer in August and had been so ill in the preceding months that he never actually worked at the facility when the residents were there. One of the few points that residency officials and the residents agree on is that Seng's death was a major blow to the potential early success of the program.

Ippolito and Aldridge say unkept promises included:

-- Each resident would perform more than 100 dental implants in two years. To date only two implants in one patient have been performed at the residency.

-- There would be 30 to 40 patients' cases per resident established before they arrived in July. The residents claim there were none when they started.

-- The majority of patients would have some form of insurance -- PPOs, HMOs, Medicaid, etc. -- and there would be no indigents. About 60 percent of the program's patients are indigent and pay nothing for the services.

-- The residency clinic on West Charleston Boulevard near Shadow Lane would be fully operational before they arrived. The residents say much of the equipment was not hooked up when they arrived and that some of it still is not working to its full capacity.

-- Licensing requirements would be in place before the residents arrived. The residents were ordered early in July to stop seeing patients until restricted permits could be issued to their supervisor. In effect, the residents were classified as students.

"Being called a student is insulting, especially for Duke and I who at the time were licensed to practice dentistry in other states," Ippolito said. "One of the promises was that we would be treated like colleagues, not students."

"You have to ask yourself," Aldridge said, "why would we come to Las Vegas to enter a new, unproven residency program when we were among the top students in the country and could have gone to any fully accredited program?

"You also have to ask yourself, why would we buy homes here, drag our families across the country and enter this program if we did not intend to stay the full two years? If you consider those questions, then the only obvious answer is that we were made many, many, many promises that have not been kept."

Ippolito and Aldridge have hired Las Vegas attorney Jerome DePalma to represent them in efforts to be compensated for their claimed losses.

"I want to make it clear that neither Dr. Ippolito nor Dr. Aldridge want to hurt the residency program or the UNLV dental school, but there are damages they suffered to the loss of their professional earning capacity," DePalma said, declining to release the amount sought. "I am hopeful we can resolve this."

That may be difficult, as the program's officials feel they have done nothing wrong and that the residents already have been compensated.

Karl Armstrong, assistant general counsel for the University and Community College System of Nevada, says that Ippolito's and Aldridge's salaries were more than double those of dental residents elsewhere.

"Also, we are talking about public (taxpayer) money here," Armstrong said.

While Bauer agrees to an extent with his colleagues about some of their concerns, he says he accepts that there always are going to be problems with new programs.

"I was told when I was recruited that this would be a state-of-the-art program but that there would be politics involved," 43-year-old Bauer said during a break at the school Tuesday. "And I also knew that from my experience in academics that it takes a lot of work to get programs going."

The politics Bauer referred to involves some members of the local dental community who purportedly want the residency program and the planned UNLV School of Dentistry to fail because the programs could create competition for services.

Aldridge and Ippolito say they became residents to practice sophisticated techniques like dental implants, root canals and crowns, not to fill cavities and extract teeth, which has been the bulk of their work.

"I'm just an optimistic person," Bauer said. "This (residency program) is a business that needs time to develop. Before we will get patients who need crowns and implants, we will get patients who need fillings and extractions. In time it will grow."

Bauer noted that during the past summer when he and the other residents were not allowed to practice while restricted licensing was being approved, he took the Western Region Board Exam to become eligible for full licensing in Nevada and other states.

Aldridge had previously passed that board exam, while Ippolito had passed the North East Region Board Exam.

All of the residents came into the program with terrific credentials. Ippolito graduated No. 1 in his class at the Buffalo School of Dental Medicine in New York. Aldridge graduated in the top 5 percent of his class at the University of Texas Health Science Center in San Antonio.

A dental graduate from the University of Maryland, Bauer was for eight years professor of medical illustrations at Johns Hopkins University. He also co-authored and illustrated the medical textbook "Cross Sectional Anatomy of the Head and Neck."

Rawson speaks proudly of the nearly $220,000 worth of dental work the residency program and its 37-foot mobile unit have provided to the community since July 1.

Dr. George McAlpine, Seng's replacement, vows that the program will continue to fill its openings with top-notch candidates.

"We have three people interviewing for the program," McAlpine said. "They came to us even though they were not picked the first time around because they still believe in it. And we will not lower our qualifications."

Rawson said social service agencies, hospitals and Medicaid are making referrals of potential patients to the program to increase what has been a low patient pool.

But, he cautions that residency "is not all just about seeing a lot of patients each day. It is also about, among other things, attending lectures, doing lab work and making on-call rounds at hospitals. At this time eight patients per day is a good number."

Aldridge and Ippolito say the number of daily patients at the residency facility is closer to four or five. They say that the lack of patients was a big factor in their decisions to leave.

In his address to the regents, Rawson said he will stress that "residency is still a viable and needed program."

The cost of the first two years of the residency program is $1.3 million from the Estate Tax Fund, the state's share of federal inheritance taxes. Program officials still hope to increase the number of dental residency slots from three to six next year.

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