Magazine article The Exceptional Parent

Why Do We Always React Only after a Tragedy? Deamonte's Death Following a Toothache Was the Consequence of Poverty and a System That Did Not Fulfill Its Obligations. in This Instance, It Was Largely a Question of Poverty. Would It Be Any Different If It Was Primarily a Question of a Child with Special Health Care Needs?

Magazine article The Exceptional Parent

Why Do We Always React Only after a Tragedy? Deamonte's Death Following a Toothache Was the Consequence of Poverty and a System That Did Not Fulfill Its Obligations. in This Instance, It Was Largely a Question of Poverty. Would It Be Any Different If It Was Primarily a Question of a Child with Special Health Care Needs?

Article excerpt

In February 2007, "12-year-old Deamonte Drive died of a toothache" (1) --actually he died because his family was too poor to afford the cost of a tooth extraction (estimated to be about $80) which would have prevented the spread of an abscess to his brain. His family had temporarily lost its Medicaid coverage and a dentist could not be found to provide the needed care. He had ADHD and was a somewhat difficult patient. The irony is that the ultimate cost of his care prior to his death was more than a quarter of a million dollars.

SOME BACKGROUND

The three Driver children had never received routine dental care. When Deamonte took ill, his mother did not realize that his tooth had been bothering him. Instead she was concerned about his younger brother who "complained about his teeth all the time." When finally the mother sought help for the younger brother, the earliest that an appointment could be made with an oral surgeon was three months away. About 900 of 5,500 Maryland dentists accepted Medicaid patents. "Referring patients to specialists can be particularly difficult." (1) However, as a result of "paper-work" mix up, all the children lost their Medicaid coverage.

Eventually, Deamonte had a severe headache and was rushed to the hospital and underwent emergency surgery for a brain abscess. (The tooth was extracted, finally.) But it was too late. Two weeks later, Deamonte died. His death certificate listed two conditions for the cause of death, both associated with a brain abscess: "meningoencephalitis" (an infection or inflammation of the membranes which cover the brain, and the brain itself) and "subdural empyema" (collection of pus within a naturally existing anatomical cavity)." The bill for just the hospital two week period was expected to be between $200,000 and $250,000.

MEDICAID

"In spite of efforts to change the system, fewer than one in three children in Maryland's Medicaid program received any dental services at all in 2005, the latest year for which figures are available from the federal Centers for Medicare and Medicaid Services." (1) Fewer than 16% of Maryland's Medicaid children received restorative services, such as fillings in 2005. The figures were worse for Medicaid dental services in the District of Columbia, 29% received treatment and in Virginia, 24% were treated. (1)

The Medicaid dental program was established to ensure that needed dental services were obtainable for poor children and adults. While dental services are required for children under the Early Periodic Screening, Diagnosis and Treatment (EPSDT) Medicaid program, dentistry is an elective service for adults. The availability of dental services under this joint federal-state financed program, together with the State Children's Health Insurance program (SCHIP) (which covers additional low-income children who do not qualify for Medicaid) is a major determinant in the receipt of services for those living in or near levels of poverty and individuals with special health care needs.

Despite practitioner justification of inadequate finances, tortuous administrative arrangements and paperwork, as well as missed patients appointments, the media continually emphasizes the unwillingness of dentists to provide care to Medicaid patients with the result that " ... fewer than one-third of children covered by Medicaid received any dental treatment at all." (1)

REACTIONS AFTER THE TRAGEDY

After the national news media picked up the story there were the expected finger pointing and government committee hearings to determine how such a tragedy could occur. …

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