More toothless Texas inmates to get dentures, not just pureed food

David Ford, an inmate at the Huntsville Unit who has had trouble getting dentures while in prison, shows his mouth while posing for a photo on Sept. 14, 2018 in Huntsville, Texas. Inmates without teeth in Texas are routinely denied dentures because state prison policy says chewing isn't a medical necessity and that they can eat blended food. The prison system is now in the process of getting Ford dentures. less David Ford, an inmate at the Huntsville Unit who has had trouble getting dentures while in prison, shows his mouth while posing for a photo on Sept. 14, 2018 in Huntsville, Texas. Inmates without teeth in Texas ... more Photo: Jon Shapley, MBO / Associated Press Photo: Jon Shapley, MBO / Associated Press Image 1 of / 20 Caption Close More toothless Texas inmates to get dentures, not just pureed food 1 / 20 Back to Gallery

The Texas prison system is changing its denture policy — creating a dedicated denture clinic and hiring a prosthodontic specialist — in an effort to ensure that more inmates get teeth.

The move to amp up dental care comes after a Houston Chronicle investigation found that toothless and nearly toothless inmates in Texas prisons were routinely being denied dentures and instead offered pureed food.

“We want to see more dentures prescribed," said Dr. Lanette Linthicum, medical director for the Texas Department of Criminal Justice.

Aside from the new policy proposal and clinic creation, the prison system plans to review denture-related grievances from the past year and re-evaluate those prisoners who filed complaints, hold training for unit dentists to clarify when dentures are necessary, and put together a review board to look at who needs dentures and who doesn’t.

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The changes — some of which are already underway — drew laudits from advocates, though some said the issue still speaks to the need for independent oversight of the prison system.

“It’s amazing,” said Doug Smith of the Texas Criminal Justice Coalition. “But it shouldn’t take this. I think TDCJ should want independent oversight as much as the community.”

State Sen. John Whitmire, D-Houston, said he is glad the state responded “correctly” but expressed disappointment that refusal to give dentures had ever been a problem in the first place.

“The state has a responsibility for the safety and welfare of the citizens we incarcerate,” he said. “I just expect them to provide proper care before I read about it in the Chronicle.”

ORIGINAL STORY: Toothless Texas inmates denied dentures in state prison

In 2016, prison medical providers approved giving out 71 dentures to a population of more than 149,000 inmates, many of whom are elderly, have a history of drug use or came from impoverished backgrounds with sub-par dental care.

A yearlong Chronicle investigation included correspondence from more than two dozen prisoners who told of their failed efforts to get teeth, their difficulties chewing and their reluctance to switch to a diet of pureed cafeteria food — the alternative offered in most instances for those without teeth.

Some said they’d had all their teeth removed with the false promise of dentures to come. Others lost them over time, or came in with dentures that broke, only to learn that the prison system wouldn’t agree to replace them. Some filed grievances and request forms but were repeatedly denied — sometimes by staffers citing policies no longer in place, other times by dentists claiming they couldn’t get teeth unless they became underweight.

The long-standing policy at the time only allowed for dentures in situations of “medical necessity” — and chewing didn’t count. One medical director framed the blended diet as a “better solution than the mastication and chewing process.” It was, he said, a “misunderstanding” that teeth were necessary, an assertion some correctional dental specialists disagreed with.

“Prison shouldn’t be just about bare physical survival,” Fred Cohen, a retired law professor who authored a book on Correctional Managed Health Care and the Law, said last month. “That’s the outer fringes of how a civilized society would operate.”

Although the prison system routinely revisits its policy, prison spokesman Jeremy Desel said over the summer that there were no changes expected at the time.

“The current dental prosthetic policy was last reviewed in April of last year,” he said then, “and there are no plans for it to be reviewed again in the future.”

But on Wednesday, that all changed. The system’s three medical directors and three dental directors met to discuss possible changes and came away with a series of plans.

“We looked at our current policy on dental prosthetics and we made some changes,” Linthicum said. “I think the most significant change is that we went into more detail about what is a medical necessity.”

The new policy isn’t finished yet, but when asked whether the new language would expand the definition of medical necessity to be more expansive, Linthicum said, “That’s sincerely our hope.”

Though the prison system can implement the policy as soon as it’s done, the new language won’t be formally adopted until December, when the Correctional Managed Health Care Committee holds its next quarterly meeting.

Before then, though, there are other changes the prisons can make without additional approval. They’re already working on figuring out a site for a unit-based denture clinic, where prisoners could be fitted for prosthetics if unit dentists determine they qualify.

The department already has in place a similar system for some other medical needs, including glasses and prosthetic limbs.

To man the new clinic, the prison system will bring in a dentist who specializes in dentures, Linthicum said.

Officials will also put together two review boards — one for the facilities that receive health care from the University of Texas Medical Branch and another for the facilities that receive it from Texas Tech University Health Sciences Center. The boards will be made up of dentists who will evaluate the cases of prisoners seeking dentures.

One of the boards’ first tasks will be to evaluate all of the past year’s “Step 2” grievances — those inmate complaints that have escalated beyond an initial round of review — to figure out which ones might be good candidates for dentures.

Linthicum said she’s already asked both of the prison medical providers to hold meetings with unit dentists “to do some education on the meaning of medical necessity.”

The new measures could represent a return to a more giving policy of years past.

At one point, inmates made dentures in-house as part of a vocational program.

Then in 2002, the prison system came out from under decades of federal oversight. The following year, the denture-making program was cut, though it’s no longer clear why, according to Desel, the prison spokesman.

Around the same time, according to Linthicum, there was a budget crunch putting pressure on prison healthcare. When that combined with the realization that Medicaid and Medicare didn’t provide dentures, officials began shifting their policies and practices.

“At some point you had to make some hard decisions,” she said. “Do I treat the diabetics or do I provide dentures?”

Afterward, the availability of dentures fell sharply. In 2004 — the earliest year for which UTMB and Texas Tech could supply data — prison medical providers ordered 1,295 dentures. It’s not clear whether those figures included partial sets.

The following year, that number fell to 518 and then 258. The two providers combined have ordered fewer than 100 dentures every year since 2010, according to data obtained under the state’s open records law.

Those numbers stand in stark contrast to some other states that more routinely give out dentures to inmates in need. In California — where prison health care has been at least partially under court-appointed oversight since 2006 after a class-action lawsuit — the prison system provided a total of 4,818 complete and partial dentures in 2016, according to California Department of Corrections and Rehabilitation data.

But now, the numbers in Texas could see an uptick as well, though some experts remained cautious.

“I suspect it’s still going to be a fairly restrictive policy,” Dr. Jay Shulman, a Texas A&M adjunct dentistry professor who’s been an expert witness in multiple lawsuits over prison dental issues. “It sounds like it’s a step in the right direction — but it all depends on what the guidance is and how it’s interpreted.”

Keri Blakinger covers the criminal justice system, the death penalty and breaking news for the Houston Chronicle.