Monday, May 07, 2007

Desperate, heady need for dental aid

A simple toothache can be fatal.

That is the sobering message a 12-year-old Maryland boy left when, after his dental problems went untreated, he succumbed to a severe brain infection.

Deamonte Driver's life could have been spared if his infected tooth was simply removed -- a procedure costing just $80.

However, the Driver family faced obstacles with Medicaid, poverty, and access to resources, resulting in an easily preventable health problem turning deadly.

Source: Toothache Leads to Boy's Death at abcnews.com


I think by now we've all heard this tragic story.

We're all saddened, perplexed, and outraged. At least, I hope we all are. This is a devastating and completely avoidable tragedy. We should feel grief, and outrage.

And, as usual, the first people to step up and loudly start talking about reform are...politicians.

And, as usual, we are all looking to the politicians to fix the problem. Through legislation.

As if we are tittle tattlers in kindergarten running to the teacher to right a wrong.

ETC: I don't mean our elected officials and public services should get off scot-free. Not by a long-shot. I am simply saying we can't rely on that as the sole source. Let's step up the plate as individuals to augment public efforts.

I say we need to grow up, folks. Grow up and take this reponsibility on ourselves. I say individuals need to step up to the plate. I say we can. We should. We must.

Whenever we talk about underserved, uninsured people who need medical care, I think we mainly consider medical doctors for general health. We don't usually consider aspects of health that even health insurance providers consider "optional" such as eyes and teeth.

This is because our health care is treatment centered to support a profit-based bottom line, rather than preventive centered, which, I theorize, would even better support a profit-based bottom line, but that's another post.

This post is actually investigative in nature, and a call to action in moral.

When I worked at a law firm as a legislative researcher, every single lawyer at the firm volunteered at a legal aid society, donating a couple or so evenings a month of free legal service to the poor who needed, but couldn't afford, legal assistance. This isn't the same as a public defense; this was contract review, advice, etc. Mostly civil. Absolutely essential. Regularly, the service provided a sort of open cattle call---first come, first served---and otherwise offered scheduled appointments and follow-up assistance. One had to qualify, of course.

I asked the lawyers about this service and their experience. They shook their heads and despaired at times; too much need, never enough people or time. They told me about people near ruin, and about people who were just a little confused. They told me how rewarding it was---how glad they were to be able to take their skill and help people who needed it, but couldn't otherwise afford to get the help needed.

Lawyers have a bad rap. Greedy, self-serving, rejected in countless jokes at Heaven's Gate. And yet...there is legal aid.

So...where is dental aid, and optical aid?

Initial search results were pretty empty. I found some great programs...abroad.

Domestic programs were a challenge. I did find a model in the Boulder, Colorado area that looked successful and great. It even looks like it provides mobile care.

Locally, I found that a dental society teamed up with a hospital one day in April in 2005 to provide free oral health care to people. I wasn't able to find any services beyond that date. They did advertise extensively in certain areas, primarily through schools.

I tried to reach the professional dental society to see if they could direct me to any sort of dental aid locally---such as the lawyers provided---but wasn't able to reach an actual person.

(UPDATE: Reached a person. There is no effort to provide free or affordable dental care, no organized dental aid in my area. And the nearby city? Seriously...lots of need. Lots of poverty. One of the wards here is infamous for poverty. Immortalized in movies and literature many times over.)

I checked with my local emergency room. The doctors are able to identify an infected tooth, but are not set up to investigate the extent of the infection. SOP is to prescribe antibiotics and refer the patient to a dentist.

I also called several local dentists. None accepted Medicare. Only one office in this area does (that I could find). It could be quite a hike for some. I estimated about half an hour drive from where I live. I estimated about 45 minutes from one housing project nearby that houses a number of scioeconomically poor people who would need the service of this dentist. And believe it or not, despite the fact that there is no public transportation here, not every resident owns a car.

I know these real people, people without cars, without health insurance, only limited Medicare and little to no budget. I had heard stories, I had vaguely understood the difficulty...but until I walked a mile in their shoes...well...

You don't even want to know how long I spent trying to research low cost or free oral health care service options. Most people were sort of regretful, some were nice, everybody had some place else to send me for help, but ultimately, nobody I spoke to was able to directly, concretely help me.

Go ahead...try it. Try to find oral, optical, or even general health care near you. Imagine away your car and your health insurance. Imagine up a health situation. Imagine you have no disposable income at all. How successful are you at finding care you can afford and can access?

I know how sometimes health care is under the table, so to speak. I know how sometimes people unofficially help people. I know professionals who rate and rank "free" clinics (unofficially) and who direct Medicare people they know to this place rather than that place. I know how people find out the free times (and yes, there are times, two hour windows of opportunity that are not advertised...you just have to be in the world and know) at clinics. I know people who volunteer as chauffeurs.

Why?

Why is it so damn hard to find and get necessary health care?

In discussion at Sage's blog a little while back, she and a couple of other bloggers gently pointed out my pomposity and arrogance in assuming that Everyone Has Access to Choices in Health Care.

I know better. I just got submerged in my own personal situation and how I go about things.

We forget, we do.

We forget how it really is to not be able to live like we do. Or maybe we never really knew, or know.

I'm not sure---despite my occasional immersion in it---that I can even say I really know. I was able, after all, to say, after each call trying to find care for my imagined persona (based on a real person), "Wow, thank God this isn't really me, my real life."

No, I was able to say, well, the almost $2000 my family has had to pay for quality, accessible dental care recently (note the ommision of the word affordable---$2000 is killing us, and half was charged so now we have debt to pay off) is a serious pain point, but oy...at least we could somehow.

I did question the $80 to pull a tooth. What is that...ten minutes with the dentist, no pain meds or anesthesia, no x-rays...just dentist hand in mouth with pliers and yank?

I wonder because when my daughter had a tooth pulled just a few months ago it was (and I shit you not) FIVE HUNDRED DOLLARS and some change. Now, she got what I call the Royal Oral Princess treatment and an ice cream cone after.

So, what does $80 get you?

I know dentists have costs. I know they have liability. I know things aren't always fair or equal.

What I don't know is WHY every single solitary dentist can't offer one day a month, one day a quarter, half a day a quarter...something...anything of free oral health care for the people who can't afford it otherwise.

If we swung around, and got in front of dental disease (and any other health care issues--this is an open call not exclusive to dentists) and prevented problems, then I bet nobody needs to spend (or have it cost the dentist) eighty or five hundred dollars to treat a problem.

Go to schools. Do it at the schools. Do it at your office. Do it at some civic building.

Just. Go. Do. It.


Don't make me invoke the name of Jesus Christ. I will, bet it, I will.

I don't want mealy-mouthed excuses. They are all selfish. That's right. Selfish.

If you have some good reasons, something not self-serving, hand it over. Let's look at it. We can be smart, and creative. I bet we can find a way around it.

I bet Crest and Colgate will be glad to pony up sample toothbrushes and toothpaste for free.

Take my challenges.

Try to find health care with no insurance or money. See what it feels like, just a little. Call your usual health care providers and listen to their friendly, chipper tone turn frosty as you plead need, but no insurance, or money. Compare and contrast this to the usual service you get.

Health care professionals...get regular, free, health care clinics going. Not just in the inner city, but everywhere it might be needed. Volunteer. Offer it free. Get donations. Get free products from companies.

(Listen, I have done four fundraisers this year. You'd be surprised how easy begging gets to be, and how lucrative it can be. You'd be surprised how many people want to help and just don't know where, when or how. They have products or services, and just need an avenue. An avenue beyond passive activism such a national praying or forwarding emails or clicking buttons on web sites.)

Extend my challenges. Challenge health care providers to donate services.

Don't just let this story become a headline that slowly slides off the front page and out of our minds.



This is Deamonte. A real child, a real face. A boy who will never graduate high school, drive a car, go to prom, get married, try to balance a checkbook, snap photos of his kids singing in a school recital, figure out how to save up for a downpayment on a house, and so forth.

This is also the face of the uninsured, the uncared for in the country. This is a face we must never, ever forget. It's the face that needs to motivate us to give aid. It's the face that should guide us as we vote. It's the face that should guide us as we find ways to give.


copyright 2007 Julie Pippert

17 comments:

kaliroz said...

Sing on, sister.

There's no reason healthcare should cost so much. Or dental care.

500 dollars to pull a tooth?

I'm actually switching dentists because mine charges FAR too much and am looking because I need a filling replaced and my back molars checked out. I can't afford to go to my old dentist anymore.

There was another story not too long ago about a five year old who died of an infected tooth. This is the "prosperous" America we live in. Where people die from infected teeth. It's absolutely horrific.

And part of the cost problem, I think, is that we've become so litigious. I remember when I was pregnant with my daughter my OBGYN almost went out of business because their insurance wasn't going to cover them anymore which meant I was about to have to worry about traveling almost an hour to deliver my child. (It wasn't just my OBGYN but all of them in the town.)

We need universal healthcare in this country. Yes, health providers should help the needy, but should doesn't always translate into will.

While people urge doctors and dentists and whomever else to help out we still need to put pressure on the politicians. Make them DO something instead of just give lip service. It has to be a combination of individual as well as political effort or things will never change.

slouching mom said...

Oh, Julie. Spot on.

I am pleased to tell you that there is a clinic in my town staffed by many wonderful doctors AND dentists, who offer their services FREE to those who need them. It is the most amazing program, and I salute all the physicians and dentists who give of their time, as well as the woman whose idea set it all in motion.

It'a a fabulous, fabulous program.

We just need more of them.

So if this boy had lived in my town, he might have survived his ordeal.

(I will e-mail you the link to the program. I think it's THAT good. I don't really want to share where I live, though, which is why I'm going to e-mail it to you. Maybe it will inspire you and others.)

Julie Pippert said...

Roz, I agree, it needs to be a combined effort.

I am considering changing dentists as well. I think we pay for poshness we don't need. He was just supposed to be The Best.

I left out the subsequent $600 and other $200 and then the rest for a sum total of about four visits all related to the pulling of the tooth. Not to mention the regular checkup.

The additional costs were to measure and make and put in a spacer to hold the corect spot for when the new tooth comes in.

I bet $80 doesn't cover that, which will lead to later jaw and tooth problems.

The botom line is that I feel we are in this "everybody thinks it is somebody else's responsibility so nobody does it."

If we depend upon legislation and universal health care, well, that doesn't help the now, and it passes the buck.

I think we need to advocate for that, but we also need to pressure health care into providing service.

And take on personal responsibility.

***

SM, PLEASE do email me th elink. I understand the need for privacy. I have already contacted a free clinic I liked the looks of in Boulder.

If this boy had live din my town I think he would have suffered the same tragic outcome.

I don't know what but I am going to see what I can do...

thailandchani said...

Excellent!

I do have to say though that not every region is guilty of this.

As I've mentioned before, I live on a fixed income. I depend on Medicare.

Granted, I have to pay a $93.00 premium but it's worth every dime, even though it makes things a bit tight.

For an additional $13.40 a month, I have prescription drug coverage with a $3.10 copay.

Just this past month, I had cataract surgery *in the hospital*, anesthesiologist, surgeon, nurses.. monitors.. the whole works.. and paid a grand total of $131.00, my Medicare deductible. Without Medicare and Medi-Cal that operation would have likely cost several thousand dollars, all out of my pocket. I would have to file bankruptcy.

I got new glasses for nothing. Medicare.

I also see a dentist who accepts Medicare.

This came about because people in California demanded it. Medicare itself isn't bad.

Medicaid, on the other hand, outside of California, is horrible. Medi-Cal is a good system.

I think the problem lies largely in lack of information. Too many poor people don't have access to information or what is available to them.

The first logical step would be to have a clearinghouse for information. There used to be one in southern California and I no longer recall the name. Volunteers answered the phone, had a list of all community services and directed people.

If your region doesn't have at least this much, people need to start demanding it.

So... your suggestion is a good one but politicians and legislators need to be involved as well. It's a cooperative effort. :)


Peace,

~Chani

Lawyer Mama said...

Yes! I think everyone should give back to the community in the way they are best able, health professional or not. If every lawyer, doctor, dentist, accountant, nurse, teacher, you name it, helped out think about how much good they could do! (And I thank you for your comments about lawyers but many of them *don't* do pro bono work, even though it's supposed to be a professional obligation.)

I have heard that many dental schools offer free or greatly reduced services, but you have to agree to let students work on your mouth. I know people who've had good experiences though.

I keep coming to the conclusion that some form of universal health care is the only feasible solution. And I think that more and more people and business owners are going to get on board as the costs of care continue to rise. (And we can't blame that totally on lawyers, folks. My malpractice insurance has risen some ungodly amount - like 600% in the last five years. The same companies that insure doctors insure me. When insurance companies lose money on investments everyone's rates go up.) It's a broken system and we have to fix it.

kaliroz said...

Oh, we definitely need to advocate. I 100% agree with you there.

It's just so sad that we have to even be in this situation. Where a kid dies from a tooth! A tooth! This isn't the 1676 colonies. We're supposedly a civilized society.

It's just all SO insane.

Sandy. said...

With kids on Medicaid, boy do I have experience in this area. Services are tough to come by, and usually there is a lengthy wait.

Just last year, one of my sons had an infected tooth. A trip to the local emergency room got us nowhere (other than to tell us he was "constipated" - what that had to do with anything, I still don't know). Then a trip to a dentist, followed by a trip to a pediatrician, and then a different dentist. It was agreed the tooth was infected, yet no one would pull it. I found a dentist 280 miles away that would do it TWO WEEKS later. Things went from bad to worse and the infection turned into celluitis, which threatened his eye. We wound up in the emergency room at a Children's Hospital 250 miles away and being admitted for IV antibiotics (as well as tooth removal). I think the $80 to pull the tooth initially would have been a bargain, not to mention it would have saved my son a lot of pain and it would have saved some of my sanity.

Don't even get me started on pre-natal care. In our area, you CANNOT get pre-natal care if you are on Medicaid. Cannot be done. Women who probably need the care the most cannot obtain it. Ridiculous.

I hate the insurance system in this country. (After 2 1/2 years of diligent efforts, I was finally able to obtain private insurance coverage for myself. What a battle that was.)

For that 2 1/2 years, I was among the uninsured. It was frustrating and scary. Even now, my insurance stinks, but at least it is something.

Another post that makes you think.

Sandy.

K said...

We have like a bazillion dollar deductible for regular medical and zero dental, but we have means.

As you found, if you are able to find services they are not easily accessible. People don't think about the reality of others lives. If more people did as you did and really thought out the practical, --well I was going to say they would be less likely to dismiss and judge, but sadly I'm not sure that's true until we stop believing that economic prosperity is deserved or the result of hard work.

And as far as Jesus, oh yeah baby bring him, because I believe he said just what you said
"Just. Go. Do. It."

So OK maybe not in those exact words, but I do know that he didn't allow for qualifiers on the who or doing so half-assed or not at all.

Aliki2006 said...

You are so right. About everything. That story broke my heart, too--I get so angry about how little people think about all this--about the poverty and sadness and despair right here under our noses.

jen said...

amen, friend. amen.

we do have a mobile dental van in our area, it makes the stops at shelters and does some good.

it's something.

Mary-LUE said...

Wow Julie, I had missed this story. It is so heartbreaking. As the article states, the connection between dental hygiene and overall health is well documented. It is disheartening to think that dental and medical health care aid do not go hand in hand.

There is a program some people from my church are connected with which allows a person to sponsor low cost insurance coverage of children in California. I'm going to check with them to see if this coverage includes dental care. If it does, I will sign us up to sponsor one or two children right away. If it doesn't, well, I might still sign up to sponsor one or two children but I will have to think about what else I can do.

The Atavist said...

Ironically, I just got back from the dentist. I have no idea what the visit cost me because my family dental plan paid for it. When I was a child, my immigrant family was poor at first, and a visit to the dentist was rare. We could have used a donated hour or two of a dentist's time. I prefer individual charity to government operated and mandated services because the latter are inefficient and generally very costly to the taxpayer.

Kyla said...

We are uninsured. For KayTar to be properly covered through private insurance, the rest of us cannot be. Josh's insurance through work is pricey and largely useless, unless something major happened. So we made a choice. Pay close to a grand per month and still pay almost full price for all of our doctor visits, or pay full price for doctor visit and save that money that would be going into insurance. We make too much for any sort of assistance. The difference for us is that we have the money to pay out of pocket for proper medical care within reason. Many people don't have that option.

NotSoSage said...

Julie, you're so right.

Even though Canada has universal health care, the big black hole that I'm always shocked by is the lack of coverage for dental services. I hadn't heard Deamonte's story. How terrible.

But it's not just that: people with heart murmur are very susceptible to complications related to gingivitis, dentists are often the first to notice and diagnose oral cancers...there are so many reasons why dental health is closely tied to health and yet it's somehow viewed as distinct.

Until we got coverage through Joe's work, we both went 7 years without a check-up...

Queen of the Mayhem said...

This post speaks to me more than you can possibly know.

I have a student who had a HORRIBLY infected tooth. I only became aware of it after he burst into hysterical tears upon biting down on a piece of candy.

I immediately questioned him about the tooth...and the things done to fix it. He told me his mother told him that his medicaid card had not been issued yet and they could not afford it.

This led to a phone call to his mother. She told me that his medicaid was still with his dad in another state. Why had it not been switched? HMMMM...good question! I told her she NEEDED to get the ball rolling on switching it over...and I would see if I could find someone to help him.

MILLIONS of phone calls later, I found the dental school in the area did free work on deserving patients. While the students did most of the procedures....the professionals were always close at hand!

Upon calling his mother, she informed me that she was "really busy" and the school was "far away"....it was less than 30 minutes! SO, I politely offered to take him and reminded her that not getting something like this taken care of was considered neglect.....AND neglect is something I would have to report to the proper authorities.

FUNNY...she wasn't so busy after all!

Isn't it sad that it was so difficult for me to find help for this innocent child? Isn't it even more sad that I could only motivate his mother to utilize this help by threats of reporting her to child protection?

Speaks to why she was in this predicament in the first place!

Very thought provoking post!

Christina said...

Late to the discussion here, but I totally agree with you. Thankfully, my city does have free and low-cost clinics set up all over town, both through the Health Department and through various hospitals.

My aunt is a hospital administrator who is in charge of her hospial network's community outreach clinics.

Just recently the Health Department added a dentistry clinic and an OB/GYN clinic. They are very needed, especially for many of the poor immigrant families we have in town.

I was surprised they did open the dentistry clinic, though. While general health is usually taken seriously, dental health is often seen more as cosmetic. Just look at how lousy dental insurance is for many.

Our health insurance covers just about everything except vanity surgeries (it does cover reconstructive plastic surgery and even bariatric surgery), but our dental insurance covers basic cleanings and fillings, but provides practically no coverage for orthodontics and crowns, which are considered "cosmetic".

I'm going to be starting nursing school in the fall, and I seriously hope I will get to work in those free clinics to help out where I can.

Katie said...

I'm a little late to the conversation, but I think your solution is right on. I am kind of against governmentalizing health care, but it is obvious something needs to be done. I think your solution, to do it on an individual basis, is perfect.

I've been on Medicaid, when I was a young married student in Provo, Utah (where many young married students are on Medicaid). We had no trouble getting good pediatric and dental care for my baby. (I used my student insurance for prenatal care, but once I found out we were eligible for Medicaid, I was reimbursed for the co-payments I had made.) I found some records that showed that I called a bunch of dentists for my son's work (he needed a crown), and only a few accepted Medicaid. But the one we went to didn't treat us any differently that we could tell. His work was superb. We've had a high-end pediatric dentist tell us that if we hadn't told her, she wouldn't have even known my son had a crown (because the workmanship was so good on it). I am sad that it is not this easy for everyone who needs it.