With a $42 million financial hole to fill, the University of Washington’s dental school has laid off 22 people, triggering criticism over loss of specialty services. Also, Joel Berg, who had stepped down as dean but continued working at the UW, will be resigning on Sept. 15.

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More than 20 years ago, radiation and chemotherapy cured Steve Barclay of throat cancer, likely saving his life. But since then, damage to his throat from the radiation made it harder and harder for him to speak and be understood.

So he turned to Jeffrey Rubenstein, a professor of restorative dentistry at the University of Washington’s School of Dentistry and one of the few specialists in this region who could create a prosthesis to fill a gap in Barclay’s throat and make his speech more clear.

But this month, the UW’s dentistry school — which is running a $6 million deficit this year, adding to its debt of $36 million — laid off 22 people. Included in the layoff: a laboratory technologist and two patient coordinators who made up all of Rubenstein’s staff.

“Without my staff, effectively, they’ve terminated me,” said Rubenstein, who estimates he has several hundred patients across a five-state region, many of whom need ongoing care. He called his staff critical to his job.

The dental school’s interim dean, James Johnson, said there could be other dental assistants and technicians who could assist him, although he acknowledged Rubenstein’s staff was very skilled.

“It’s not acceptable,” said state Rep. Michelle Caldier, R-Port Orchard, of the cutbacks, particularly to Rubenstein’s practice. “If you’re the only place in the state that offers certain services, you should make sure there’s another place patients can go before you cut services.”

Caldier, Rubenstein and about two dozen dental-school workers and faculty appeared before the UW Board of Regents on Wednesday night to raise questions about the layoffs. They spoke during a public comment period, but the board did not take up the issue. In March, the board reviewed a consultant’s report that recommended changes to the dental school to put it on firmer financial footing, and Johnson is working on a plan to eliminate the deficit over time.

The UW dental school is considered the fourth-best dental school in the country, according to Quacquarelli Symonds, a British educational organization that ranks the world’s universities. It is the only dental school in Washington.

Exactly why the dental school is so deeply in debt is open to debate. University Provost Jerry Baldasty has said it is largely due to low reimbursement rates from Medicaid patients, many of whom can’t get private care.

But faculty members have complained for a number of years that the school is poorly managed and have faulted the university for not being more transparent about its budget.

Some have pinned the blame on the former dean, Joel Berg, who resigned the position in October. Berg continues to work at the UW, drawing a $301,980 salary teaching residents and practicing at the school’s Center for Pediatric Dentistry. On Friday, the school said Berg would be resigning Sept. 15.

Caldier, who is a dentist, said cutting clinical staff is “penny smart, pound-foolish” because the school may not be able to treat as many patients, causing its collections to fall. She said she had questions about how the university is managing tuition dollars, and has requested an external audit of the school.

The layoffs will save the school about $1.1 million over the course of a year, said Bob Wanezek, the dental school’s assistant dean for clinical strategy and planning.

He said the positions included 11 dental assistants, three hygienists and six managers. The school’s leaders chose to lay off workers they believed would have the smallest impact on patient care, Wanezek said.

Wanezek confirmed that Rubenstein’s practice will be closed, but said he thought it would “continue for a bit to make sure there are no issues related to patient continuity.”

Crafting maxillofacial prosthodontics, as they’re called, is Rubenstein’s specialty. He has been doing the work for 43 years and is one of the few dentists in a five-state area with the expertise who also takes Medicare and Medicaid, through Washington’s Apple Health program.

Rubenstein rehabilitates patients with birth disorders, head and neck cancers, gunshot wounds and injuries from automobile accidents. One recent patient from Montana was mauled by a grizzly bear. Rubenstein rebuilds jaws, makes prosthetic noses, fixes cleft palates and reconstructs faces with bone grafts, implants and other materials.

“I can’t even put into words how distressing this is personally,” said Rubenstein of the staff cuts. He said he had been recruited to the UW to continue a practice that was started there in 1952, and he had planned to recruit another specialist to the school before he retired so the UW would continue to offer maxillofacial prosthodontics.

“When the doors of this service are closed, hundreds of patients who need ongoing care will find the closest place to seek this care is San Francisco,” he said.

Barclay, who worked for Boeing for 29 years negotiating the sale of Boeing planes to customers in Asia, said in an email that the prosthetic would cost him several thousand dollars if he had to pay for it out-of-pocket, and flying to and from San Francisco to see a different dentist would be costly as well.

In addition to losing his ability to speak, Barclay can no longer eat solid food, and he uses a feeding tube. Rubenstein was planning to create for him a palatal lift prosthesis — a removable prosthesis that, when placed in the mouth, is retained on several upper teeth. It is designed to elevate the soft palate to its intended position, where it can facilitate and normalize speech and swallowing.

Johnson said via email that some of the treatments Rubenstein offers could be completed by a prosthodontist but acknowledged that “the more advanced cases may require that patients go to another location.”

The interim dean is charged with creating a plan to close the dental school’s deficit completely by the end of the 2019 fiscal year.

“We have to look at all programs and positions,” he said. “For example, we are in the process of seeing which faculty with annual appointments we can retain. These are all very painful decisions, and they’ll be made with care and deliberation.”

In addition to the staff cuts, the school plans to close its Center for Pediatric Dentistry in Sand Point and move that department into the Magnuson Health Sciences Center, where the rest of the dental school is located.

Rubenstein said he thinks the school is missing opportunities to provide services — and therefore make more money — because of what he described as “total gross mismanagement” of the business side.

For example, he said, one of his patients requested an estimate for how much it would cost for a certain treatment; the school took 10 months to give her that estimate. In other cases, he said, insurance carriers have agreed to pay for a certain procedure, only to refuse to pay it later, and the school has failed to follow through and seek payment.

Because he is a tenured professor who teaches a class that the school must offer to remain accredited, Rubenstein says he will remain at the UW after his practice closes. But without a staff, he has no way to support patient care.

“Starting May 1, I’m going to be playing computer chess in my office,” he said.