Twelve-year-old Deamonte Driver died of a toothache
Sunday.
A routine, $80 tooth extraction might have saved him.
If his mother had been insured.
If his family had not lost its Medicaid.
If Medicaid dentists weren't so hard to find.
If his mother hadn't been focused on getting a dentist for his brother, who
had six rotted teeth.
By the time Deamonte's own aching tooth got any attention, the bacteria from
the abscess had spread to his brain, doctors said. After two operations and more
than six weeks of hospital care, the Prince George's County boy died.
Deamonte's death and the ultimate cost of his care, which could total more
than $250,000, underscore an often-overlooked concern in the debate over
universal health coverage: dental care.
Some poor children have no dental coverage at all. Others travel three hours
to find a dentist willing to take Medicaid patients and accept the incumbent
paperwork. And some, including Deamonte's brother, get in for a tooth cleaning
but have trouble securing an oral surgeon to fix deeper problems.
In spite of efforts to change the system, fewer than one in three children in
Maryland's Medicaid program received any dental service at all in 2005, the
latest year for which figures are available from the federal Centers for
Medicare and Medicaid Services.
'They know there is a problem'
The figures were worse
elsewhere in the region. In the District, 29.3 percent got treatment, and in
Virginia, 24.3 percent were treated, although all three jurisdictions say they
have done a better job reaching children in recent years.
"I certainly hope the state agencies responsible for making sure these
children have dental care take note so that Deamonte didn't die in vain," said
Laurie Norris, a lawyer for the Baltimore-based Public Justice Center who tried
to help the Driver family. "They know there is a problem, and they have not
devoted adequate resources to solving it."
Maryland officials emphasize that the delivery of basic care has improved
greatly since 1997, when the state instituted a managed care program, and in
1998, when legislation that provided more money and set standards for access to
dental care for poor children was enacted.
About 900 of the state's 5,500 dentists accept Medicaid patients, said Arthur
Fridley, last year's president of the Maryland State Dental Association.
Referring patients to specialists can be particularly difficult.
Fewer than 16 percent of Maryland's Medicaid children received restorative
services -- such as filling cavities -- in 2005, the most recent year for which
figures are available.
For families such as the Drivers, the systemic problems are compounded by
personal obstacles: lack of transportation, bouts of homelessness, erratic
telephone and mail service.
The Driver children have never received routine dental attention, said their
mother, Alyce Driver. The bakery, construction and home health-care jobs she has
held have not provided insurance. The children's Medicaid coverage had
temporarily lapsed at the time Deamonte was hospitalized. And even with
Medicaid's promise of dental care, the problem, she said, was finding it.
When Deamonte got sick, his mother had not realized that his tooth had been
bothering him. Instead, she was focusing on his younger brother, 10-year-old
DaShawn, who "complains about his teeth all the time," she said.
DaShawn saw a dentist a couple of years ago, but the dentist discontinued the
treatments, she said, after the boy squirmed too much in the chair. Then the
family went through a crisis and spent some time in an Adelphi homeless shelter.
From there, three of Driver's sons went to stay with their grandparents in a
two-bedroom mobile home in Clinton.
By September, several of DaShawn's teeth had become abscessed. Driver began
making calls about the boy's coverage but grew frustrated. She turned to Norris,
who was working with homeless families in Prince George's.
Norris and her staff also ran into barriers: They said they made more than
two dozen calls before reaching an official at the Driver family's Medicaid
provider and a state supervising nurse who helped them find a dentist.
On Oct. 5, DaShawn saw Arthur Fridley, who cleaned the boy's teeth, took an
X-ray and referred him to an oral surgeon. But the surgeon could not see him
until Nov. 21, and that would be only for a consultation. Driver said she
learned that DaShawn would need six teeth extracted and made an appointment for
the earliest date available: Jan. 16.
But she had to cancel after learning Jan. 8 that the children had lost their
Medicaid coverage a month earlier. She suspects that the paperwork to confirm
their eligibility was mailed to the shelter in Adelphi, where they no longer
live.
It was on Jan. 11 that Deamonte came home from school complaining of a
headache. At Southern Maryland Hospital Center, his mother said, he got medicine
for a headache, sinusitis and a dental abscess. But the next day, he was much
sicker.
Eventually, he was rushed to Children's Hospital, where he underwent
emergency brain surgery. He began to have seizures and had a second operation.
The problem tooth was extracted.
Deamonte appeared to be mending slowly
After more than
two weeks of care at Children's Hospital, the Clinton seventh-grader began
undergoing six weeks of additional medical treatment as well as physical and
occupational therapy at another hospital. He seemed to be mending slowly, doing
math problems and enjoying visits with his brothers and teachers from his
school, the Foundation School in Largo.
On Saturday, their last day together, Deamonte refused to eat but otherwise
appeared happy, his mother said. They played cards and watched a show on
television, lying together in his hospital bed. But after she left him that
evening, he called her.
"Make sure you pray before you go to sleep," he told her.
The next morning at about 6, she got another call, this time from the boy's
grandmother. Deamonte was unresponsive. She rushed back to the hospital.
"When I got there, my baby was gone," recounted the mother.
She said doctors are still not sure what happened to her son. His death
certificate listed two conditions associated with brain infections:
"meningoencephalitis" and "subdural empyema."
In spite of such modern innovations as the fluoridation of drinking water,
tooth decay is still the single most common childhood disease nationwide, five
times as common as asthma, experts say. Poor children are more than twice as
likely to have cavities as their more affluent peers, research shows, but far
less likely to get treatment.
Serious and costly medical consequences are "not uncommon," said Norman
Tinanoff, chief of pediatric dentistry at the University of Maryland Dental
School in Baltimore. For instance, Deamonte's bill for two weeks at Children's
alone was expected to be between $200,000 and $250,000.
The federal government requires states to provide oral health services to
children through Medicaid programs, but the shortage of dentists who will treat
indigent patients remains a major barrier to care, according to the National
Conference of State Legislatures.
Access is worst in rural areas, where some families travel hours for dental
care, Tinanoff said. In the Maryland General Assembly this year, lawmakers are
considering a bill that would set aside $2 million a year for the next three
years to expand public clinics where dental care remains a rarity for the
poor.
Providing such access, Tinanoff and others said, eventually pays for itself,
sparing children the pain and expense of a medical crisis.
Reimbursement rates for dentists remain low nationally, although Maryland,
Virginia and the District have increased their rates in recent years.
Dentists also cite administrative frustrations dealing with the Medicaid
bureaucracy and the difficulties of serving poor, often transient patients, a
study by the state legislatures conference found.
"Whatever we've got is broke," Fridley said. "It has nothing to do with
access to care for these children."
