Arizona Court of Appeals Mercifully Rules Against a State Agency That Told a Poor Woman She Didn't Need Dentures, That She Could Just Exist on a Liquid Diet

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Some years ago, Bridget Sharpe became eligible for AHCCCS, the state's health-care program for the needy. She enrolled with the program's Mercy Care Plan to receive medical services. 

teeth2.jpg

What remained of Sharpe's teeth were in a state of "rampant decay," according to an Arizona Court of Appeals decision this month. (Those perfect choppers depicted to the left are decidely not Ms. Sharpe's)

The woman's doctors and her dentist asked Mercy Care to approve payment for the removal of all of her teeth, followed by a complete set of upper and lower dentures.

Mercy Care readily approved the extraction of Sharpe's teeth, but showed no mercy as to her request for dentures, concluding that "the information reviewed does not show a medical need for the request."

Sharpe appealed that decision, and told an administrative law judge during a subsequent hearing that the woman needed roughage in her diet to aid in weight loss essential in controlling her fibromyalgia (a painful muscle and connective tissue disorder).

Then it got weird: Mercy Care's dental director, Dr. Robert Thielen, told the judge that Sharpe could meet her health needs through a liquid diet and didn't need dentures.

"A liquid diet would be sufficient in this case," Thielen testified.

The administrative law judge disagreed, noting in a written opinion that "teeth provide a function to the human body that enables people to eat normally...Dentures prevent the disability and adverse health condition of not being able to eat normally."

But AHCCCS wasn't ready to give in. The agency's director rejected the judge's findings, noting that "the ability to chew and masticate is not, in and of itself, a basic medical necessity and is not a disability."

Sharpe then appealed to Maricopa County Superior Court, but Judge Margaret Downie agreed with AHCCCS.

Jennifer Nye, a lawyer for the Arizona Center for Disability Law, then asked the Court of Appeals to take a bite at the case, which it did, spitting out the AHCCCS and Judge Downie (who now is a member of the appellate court herself) in a unanimous 31-page ruling issued February 3.

The 3-0 opinion written by Judge Daniel Barker says that Arizona law lists two requirements for state-paid dentures -- that they be "ordered by a dentist" and are "medically necessary."

The first provision was uncontested, as Sharpe's dentist clearly wanted her to have the dentures after losing the rest of her teeth. And as for the "medically necessary" part, Judge Barker pointed out that AHCCCS earlier had confirmed the administrative law judge's finding that Sharpe "must have all of her teeth removed due to dental disease."

From the appellate opinion: "With no teeth, Shape falls squarely within the category of persons that the Legislature contemplated would receive dentures; she has lost her ability to chew, and it may be restored with the provision of dentures."

Now, that's something to chew on.

We're not sure yet what's going to happen with Bridget Sharpe's teeth (and her dentures), or if AHCCCS is going to appeal the recent ruling to the Arizona Supreme Court. When we find out, we'll let you know.

 

 

 

 

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13 comments
Samantha
Samantha

You can't live on a liquid diet for very long and plus that is just rude to tell a patient, even if she is old.  I hope this dentist loses his or her license. secondary containment Alberta

Samantha
Samantha

You know that when you can't trust your dentist you are doing something wrong. I think it's just sick and wrong. windows Boise

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