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<DIV><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Maryland</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"> boy, 12,
dies after bacteria from tooth spread to his brain</SPAN></FONT></DIV>
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<P class=MsoNormal><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">By Mary
Otto</SPAN></FONT></P></DIV>
<DIV>
<P class=MsoNormal><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">The </SPAN></FONT><FONT face=Arial
size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Washington</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">
Post</SPAN></FONT></P></DIV>
<DIV>
<DIV id=udtD>
<P class=MsoNormal><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Updated: </SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">11:11 a.m.
CT</SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"> </SPAN></FONT><FONT face=Arial
size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Feb 28,
2007</SPAN></FONT></P></DIV></DIV>
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style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">
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</SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">WASHINGTON</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"> -
Twelve-year-old Deamonte Driver died of a toothache Sunday.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">A routine, $80 tooth extraction
might have saved him.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">If his mother had been
insured.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">If his family had not lost its
Medicaid.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">If Medicaid dentists weren't so
hard to find.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">If his mother hadn't been focused
on getting a dentist for his brother, who had six rotted
teeth.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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 </SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Prince George</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">'s County
boy died.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><STRONG><B><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">‘They know there is a
problem’</SPAN></FONT></B></STRONG><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"><BR>The figures were worse
elsewhere in the region. In the District, 29.3 percent got treatment, and in
</SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Virginia</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">, 24.3
percent were treated, although all three jurisdictions say they have done a
better job reaching children in recent years.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">"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."</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Maryland</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"> 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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Fewer than 16 percent of
</SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Maryland</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">'s
Medicaid children received restorative services -- such as filling cavities --
in 2005, the most recent year for which figures are
available.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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
</SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Clinton</SPAN></FONT><FONT
face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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 </SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Prince George</SPAN></FONT><FONT
face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">'s.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><STRONG><B><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Deamonte appeared to be mending
slowly</SPAN></FONT></B></STRONG><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"><BR>After more than two weeks of
care at Children's Hospital, the </SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Clinton</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">
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 </SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Foundation</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">
</SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">School</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"> in
</SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Largo</SPAN></FONT><FONT
face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">"Make sure you pray before you go
to sleep," he told her.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">"When I got there, my baby was
gone," recounted the mother.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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."</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Serious and costly medical
consequences are "not uncommon," said Norman Tinanoff, chief of pediatric
dentistry at the University of Maryland Dental School in </SPAN></FONT><FONT
face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Baltimore</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">. For
instance, Deamonte's bill for two weeks at Children's alone was expected to be
between $200,000 and $250,000.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Providing such access, Tinanoff
and others said, eventually pays for itself, sparing children the pain and
expense of a medical crisis.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Reimbursement rates for dentists
remain low nationally, although </SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Maryland</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">,
</SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Virginia</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"> and the
District have increased their rates in recent years.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.</SPAN></FONT></P>
<P class=textbodyblack><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">"Whatever we've got is broke,"
</SPAN></FONT><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Fridley</SPAN></FONT><FONT
face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"> said. "It
has nothing to do with access to care for these children."</SPAN></FONT></P>
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