May 25, 2011 Liz Borkowski, MPH 4Comment

I read a lot of stories about how our healthcare system fails people, but one of the ones that’s stuck with me the most is the tragedy of 12-year-old Deamonte Driver, who died in 2007 after bacteria from an abscessed tooth spread to his brain. Deamonte and his brother were covered by Maryland’s Medicaid program, but their mother, Alyce Driver, struggled to find a dentist that would accept Medicaid and had appointments available. Then, their coverage lapsed, mostly likely because their paperwork was sent to the homeless shelter where they’d been staying after they moved on to other housing arrangements. When Deamonte’s infection was eventually discovered, he underwent emergency brain surgery – but it was too late to reverse the disease that could have been prevented by a routine tooth extraction.

Mary Otto wrote the Washington Post article about Deamonte Driver’s death – and earlier this year she reported on the Deamonte Driver Dental Project, whose mobile dental clinic made its first stop at Driver’s old school in Largo, Maryland. Otto describes the response to the tragedy, which resulted in some significant steps for children’s oral care:

A succession of congressional hearings probed the problems, with a large picture of Deamonte’s face displayed on video monitors around the hearing room.

“With all the resources available to us, how did we so thoroughly fail this little boy?” asked Rep. Elijah E. Cummings (D-Md.).

The hearings revealed a system in disarray. A review of the records of UnitedHealthcare, the managed-care organization that shared responsibility for Deamonte’s care at the time of his death, concluded that thousands of Maryland Medicaid children had not seen a dentist in years. The review, faulting both UnitedHealthcare and the system, also found that families confronted major barriers to finding participating dentists. Cummings’s subcommittee concluded that an inadequate number of dental providers was a problem nationwide. Reforms were demanded.

“Deamonte took us by the hand . . . and escorted us through the health-care system and pointed out all the places where we could improve,” Rep. John Sarbanes (D-Md.) said this month at a news conference honoring the boy’s memory.

Maryland’s congressional delegation helped add a dental entitlement to the reauthorization of the State Children’s Health Insurance Program, which covers children in slightly higher income groups than Medicaid does. The delegation also fought to get children’s oral health care provisions into the federal health-care reform law, said Sen. Barbara Mikulski (D-Md.).

While these steps were important, they haven’t yet translated to major nationwide improvements. Otto cites a Pew Charitable Trust report that estimated 17 million children in low-income families still lack access to dental care – but she also describes steps DC, Maryland, and Virginia have taken to improve poor children’s access to oral care, and notes that Maryland is now one of the few states to get an A grade from Pew on this issue.

We’re still a long way away from adequate oral care for everyone – and as Otto notes in a recent article for Street Sense, homeless adults are another population with major unmet oral-care needs. We may see more tragedies like that of Deamonte Driver in the coming years; I just hope that they manage to spur other states to follow Maryland’s lead and turn sorrow into action.

Here’s an interesting side note: I missed the Washington Post story about the Deamonte Driver Dental Project when it was published back in February, and just saw it now because Mary Otto wrote a post about it at Reporting on Health. Otto explains that she worked for the Post back in 2007 when she wrote the first story about Driver, but then was one of the many reporters and editors who lost their jobs through downsizing. She was able to go back to the story nearly four years later with the help of a grant from the Dennis A. Hunt Fund for Health Journalism, which supports reporting on critical health issues facing underserved communities. I’m glad to see philanthropists funding this kind of important journalism, but I also wonder how much high-quality health reporting we’re missing out on now that traditional news sources have cut their reporting staffs.

4 thoughts on “Learning from a Tragedy: Improving Oral Care for Low-Income Children

  1. This is very sad. One of my family members works for a dental and orthodontics office that accepts Medicaid, and many of their patients drive for an hour to get to them, because they can’t find anyone closer. Yet dental care seems to be something always up for cutting from Medicaid in the legislature. This story underscores the importance of dental treatment and why it is a major public health issue, not an “expendable item”. The BCBSNC Foundation is offering grants to clinics offering free dental care- hopefully other foundations will realize the importance and follow suit.

  2. Makes me glad I work at the School of Dentistry at USC. We’ve made it a priority to provide dental services and mobile clinics to the people in the low income areas immediately surrounding the campus. This kind of thing should never happen in this country.

  3. Liz,
    Hopefully these journailsts will find a new life by blogging and a way to make a living through advertising on the blogs.

    Speaking of revenue, how much do you charge to guest post on medical blogs? I may have need of your writing services for some medical blogs. I also have a medical client, JRSmedical interested in paying a small fee to be listed as a simple text link in your left navigation under blogroll or a new category like “Medical Resources”. Please contact me.
    – David

  4. David, we’re lucky that we don’t rely on this blog for income and don’t need to sell our space or services. If you’re interested in advertising on any one of the ScienceBlogs, contact Seed Media Group.

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