[Vision2020] Maryland boy, 12, dies after bacteria from tooth spread to his b

[keely emerinemix]

Thanks, Bill, for posting this tragic story.  I can attest from my work with 
immigrants in Western Washington that lack of access to dental care is often 
the biggest healthcare deficiency poor people experience.  It's one thing 
for my husband and me -- we don't have dental insurance -- to have to pay a 
couple thousand for my son's recent wisdom teeth extraction.  That's 
difficult, but our credit rating is top-notch, so we can make payments for a 
year with no interest.  If we were on Medicaid, or had bad credit, or 
couldn't afford to get to a dentist for regular checkups to reveal a problem 
with wisdom teeth, my son would be up a creek.

But that's the difference between being in a financial crunch or having a 
large expense come up at a less-than-opportune time and truly being poor.   
Our situation is a drag, but it's not imperiling -- we'll still eat well, go 
to movies occasionally, and send the boys to college.  Poverty, whether in 
the U.S. or elsewhere, is a grinding, life-altering, long-term, entrenched 
condition, not just an cash crunch.  And while it sometimes comes about 
because of bad decisions, it is more often a result of societal injustice 
and the indifference of the "haves" toward the "have nots."

The proof of that, I think, is evidenced by the reaction some will have to 
what I wrote -- not grief over the death of a child from poverty so 
suffocating that a bridge of less than a hundred bucks couldn't be crossed, 
but scorn and derision that I would suggest that the mockers are in any way 
culpable for the maintenance and guarding of that bridge.

A boy didn't die from a rotten tooth, but because we don't think that the 
lives of poor people matter a whole lot.  How "pro-life."

keely


From: "Bill London" <london at moscow.com>
To: <vision2020 at moscow.com>
Subject: [Vision2020] Maryland boy, 12,dies after bacteria from tooth spread 
to his brain
Date: Wed, 28 Feb 2007 11:32:20 -0800

Maryland boy, 12, dies after bacteria from tooth spread to his brain
   By Mary Otto

   The Washington Post

   Updated: 11:11 a.m. CT Feb 28, 2007

   WASHINGTON - 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."

   © 2007 The Washington Post Company




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