By Mary Otto
Washington Post Staff Writer
Thursday, May 3, 2007
The case of Deamonte Driver, the 12-year-old Maryland boy who died because of a dental infection, sparked a wide-ranging hearing on Capitol Hill yesterday as lawmakers delved into the difficulties the poor face in getting access to dental treatment.
Rep. Dennis J. Kucinich (D-Ohio), chairman of a subcommittee looking into gaps in Medicaid coverage, had his staff call dentists on a list available to the mother of the Prince George's boy who died Feb. 25 of an infection that began with an abscessed tooth and spread to his brain.
Of the 24 dentists listed as participating in United Healthcare, a managed care organization serving area Medicaid beneficiaries, none could have helped him, Kucinich said. Telephone numbers for 23 were disconnected, incorrect or belonged to a dentist who did not take Medicaid patients. The 24th was an oral surgeon.
Government regulators, who depend on managed care organization data to assess the effectiveness of Medicaid, "would have believed that the number of dentists who could have served Deamonte was 24," Kucinich said. "But the real number is zero."
An official from United Healthcare was quick to rebut Kucinich. In an interview, Peter Ashkenaz said: "We've got 92 dentists in Prince George's County, and in 2006 we paid claims to 78 of them. I don't know where he is pulling that from."
Deamonte's death drew national attention to the problems of those without access to dental care, prompting calls for change. Sen. Benjamin L. Cardin (D-Md.) has co-sponsored a bill that would provide millions in federal dollars to increase dental care for the poor.
A large photo of the boy gazed down from two large screens, as his story was interwoven throughout much of the hearing.
"With all the resources available to us, how did we so thoroughly fail this little boy?" asked Rep. Elijah E. Cummings (D-Md.).
In Maryland, a survey of more than 700 dentists listed as Medicaid providers found 170 who said they would take a new Medicaid patient, said Norman Tinanoff, chairman of the Department of Pediatric Dentistry at the University of Maryland Dental School.
Prince George's County has 45,000 to 50,000 child Medicaid participants, yet only about 50 dentists on a list provided by the county health department will see them, Temple Hills dentist Frederick Clark said.
"With this disproportionate ratio of patients to providers, it is virtually impossible for a parent to find a dentist to treat their child's dental concerns," Clark said.
At the time Deamonte fell ill, his family's Medicaid coverage had lapsed. Yet even on Medicaid, his mother, Alyce Driver, said her children lacked regular dental care and she had great difficulty finding a dentist. It took seven months of effort for her to get treatment for a younger son whose dental problems had originally seemed more pronounced than Deamonte's. The treatments came only after the mother reached out for help, said Laurie Norris, a lawyer from the Baltimore-based Public Justice Center, who testified at the hearing.
"It took the combined efforts of one mother, one lawyer, one help-line supervisor and three health-care case management professionals for a single Medicaid-insured child," Norris said.
The state's Medicaid reimbursement rates, which ranked lowest in the nation in 2004 for restorative procedures, are a deterrent for some dentists, Tinanoff said.
"An illustration of the problem is the current reimbursement rate for dental sealants," he said. Maryland Medicaid pays $9 per sealant, a fraction of the going rate.
Burdensome paperwork and the level of need presented by poor families also discourage dentists, Clark said.
Despite recent efforts to change the system, fewer than one in three children in Maryland's Medicaid program received dental service in 2005, the latest year for which figures are available from the federal Centers for Medicare and Medicaid Services. Specialty procedures -- including fillings, extractions and surgery -- are particularly hard to obtain.
A 2004 study cited at the hearing found that fewer than one in five Medicaid-covered children nationally had received a single dental visit in the previous year.