Watsonville voters, city officials and the state dental association foundation have set in motion what may be the definitive battle over fluoridating public water in California — or at least the first formal test of the 1997 law requiring it.

In November, Watsonville voters approved an ordinance that effectively bans fluoridating its water. The city, however, already had received a grant from the California Dental Association Foundation to help pay for fluoridation. The 1997 state law orders public water systems to fluoridate if funding is made available.

Opponents of fluoridation call the law toothless. A court test could determine just how serious California is about adding fluoride to public water. Public health experts say fluoridation is an effective way to prevent tooth decay, especially among poor children who have less access to dental care.

“This really is the model test case for where we are going in California,” said Jon Roth, director of the California Dental Association Foundation. “All eyes are on Watsonville.”

And on state regulators.

“If indeed there is funding made available,” said David Spath, a state health official, “then the law does take effect and we would have to implement the law.”

Asked how that would be done, Spath, who is chief of the California Division of Drinking Water and Environmental Management, declined to say. He referred further inquiries to a department spokeswoman, Lea Brooks.

Brooks said the department has not reached a decision yet and is going to consider its options.

Though the law has been in place for more than five years — and voters in a number of cities have since passed and rejected fluoridation measures — the state so far has not had to enforce the law. Watsonville is the first city to reject fluoridation after funding was secured.

“We’re waiting to see if anything’s going to happen,” said Watsonville Mayor Richard de la Paz Jr.

Asked for bids

The state Department of Health Services notified the city in March — after it received the dental association foundation grant — that it was “hereby required to complete the installation of all equipment necessary for fluoridating the drinking water supply within two years of the date of this letter.” The city council asked for bids on the equipment in the summer.

But spurred on by Citizens for Safe Drinking Water, a San Diego-based organization that is one of the nation’s leading anti-fluoridation centers, Watsonville voters passed Measure S, which, while not mentioning fluorides, effectively forbade them by banning the addition of substances not approved by the federal Food and Drug Administration — which has no authority over public water supplies. The vote was 51 percent in favor of the ban.

City councils can approve fluoridating water supplies without an election, though the recent trend has been to put the matter before voters. Watsonville’s contract with the dental association foundation allowed it to back out if a public vote went against fluoridation.

Disputed claims

The practice of fluoridating water is widespread in the United States, though not in California, as a means of improving dental health. Public health experts say its efficacy in reducing cavities has been widely studied and thoroughly proved, and the backers of fluoridated water are often medical and dental professionals.

Opponents object to fluoridation on a number of grounds, which historically have had a Cold War, communist-plot tinge. Current arguments focus on the effectiveness of the treatment and the inefficiency of drinking water as a delivery system even if fluoridation does work, which they say is unproven. For the cost of fluoridating Watsonville’s water for a year, one opponent pointed out, you could hand out a lot of toothbrushes and toothpaste.

San Jose is listed as the largest city in the United States without fluoridated public water supplies, although the Evergreen area voted to fluoridate in 1963, and the San Jose Water Co., which serves 80 percent of the city, plans to fluoridate as soon as it secures funding, according to a company official.

San Francisco fluoridated in 1951, Oakland in 1976, and Sacramento in 2000. Mountain View fluoridated in 2001 with help from a CDA Foundation grant. Other cities, such as Sunnyvale and Santa Cruz, oppose fluoridation and claim exempt status because of lack of funding.

If the state pursues legal action in Watsonville, the outcome may rest on defining “funding.”

Watsonville’s agreement with the CDA Foundation provided $946,000 for equipment, installation and one year’s operation of the system. But the contract also required that the system remain in place for 10 years. That left a nine-year gap in funding for the city to cover at a rate of $125,000 to $150,000 a year — and that opened one of the many loopholes in the 1997 law.

The foundation felt it closed the loophole when, after the election, it offered Watsonville a revised, one-year contract. The city council rejected it.

“It does seem impractical to spend over $800,000 to install a fluoridation system that would only be used for the one year,” City Manager Carlos Palacios wrote Roth, the CDA Foundation director.

The Watsonville council will meet Tuesday, when it is expected to reject the bid for installing the system.

“The council just decided to accept the outcome of Measure S,” De la Paz said. He called it “our obligation” to the voters, despite his personal opposition to the measure.

Council member Judy Doering-Nielsen, who supported the anti-fluoridation measure, said she hopes its passage and the city’s letter to the CDA Foundation exercising the termination clause will settle the matter. “I would hope to heck that people do not become zealous and try to make us a case city.”

It probably won’t be that simple, however.

Funding is key

Roth said that the money is still available to Watsonville, and that the Fluoridation Work Group could continue to consider it available even after the contract with Watsonville is terminated. The work group is an interagency committee whose members include representatives of the state, the Dental Health Foundation, and the CDA Foundation.

The state could determine that if the money is available, the state’s enforcement letter remains in effect regardless of the voters’ decision.

That was the opinion before Nov. 5 of Watsonville City Attorney Alan Smith, quoting opinions by the California attorney general and the legislative counsel.

Initially, Spath, the state health official, said the 10-year clause in the Watsonville grant agreement made his March 8 enforcement letter essentially unenforceable.

However, told that the CDA Foundation had offered to substitute a one-year deal, Spath said that changes things.

“That would enable us to enforce the law,” he said. “We’ll see what happens from there.”

Spath said the next move belongs to the CDA Foundation. Roth said the ball was in Spath’s court: “It’s basically up to the Department of Health Services whether they want to enforce the regulations for fluoridation or not.” Neither would predict how things might go.

“The state’s never really enforced this law,” said Marta McKenzie, the public health director for Shasta County, which includes Redding, where voters passed an identical law banning fluoridation in November. “We’re all in uncharted territory here,” she said, and she doubted that Watsonville’s funding-rejection letter would be decisive. “I don’t see it getting them out of the jam yet.

“I think we’re getting to the place where we’re realizing we’re going to be in court one way or another.”

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San Jose Mercury News (California)

January 16, 2003

Letter to the Editor:

Jan. 9 Mercury News article pointed out that Watsonville is in “uncharted territory.” On one hand, Watsonville voters approved Measure S to establish safety regulations for drinking water. On the other hand, the state government is trying to invalidate the measure.

The best way to analyze the conflict is to give thought as to what is the best way to go about placing medications into the public drinking water. The safety and effectiveness of medicating additives should be verified by a public and accountable agency which is a recognized authority for such a task. Doesn’t it make sense to assign such a task to the Food and Drug Administration? Doesn’t it make sense that any medicating additives should be free of toxic metals such as lead or arsenic?

If these points make sense, the ultimate irony is reached when one finds out that Measure S does nothing more than implement these two simple requirements. Yet, the fact remains that the state government is opposed to them.

The unanswered questions that linger are: Why does the state oppose verification of the safety and effectiveness of ingested fluoride, and why does it oppose the city’s efforts to keep lead and arsenic out of the public drinking water?

Nick Bulaich
Watsonville