The tragic and needless death of Deamonte Driver, a victim of dental disease

Mary Otto, the author of Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America, devotes a chapter to explaining in detail the circumstances that led to the death of 12-year-old Deamonte Driver in March 2007, when bacteria in one of his teeth traveled to his brain. Otto ties his death to the social conditions that were its cause. It is a story that highlights the horrific social conditions that are devastating the lives of the working class.

The Capital Beltway divides Maryland’s Prince George’s County between those living in extreme poverty and, what was called in a feature by Ebony magazine, “America’s Wealthiest Black County.” Residents there own yachts, play golf and live in gated communities. “Here we are 40 years after the Civil Rights Movement—and we are the first generation to assume this kind power—it’s our time,” Gary S. Murray, a black venture capitalist and developer, told the magazine.

The Drivers were a poor working class family relying on Medicaid for health care. Alyce Driver, Deamonte’s mother, grew up in Brandywine, a rural area outside the Capital Beltway.

Alyce’s great grandparents bought 10 acres of land for $5 in 1921. Her grandfather inherited the land and farmed it, as did his son, until the tobacco growers left. The land was sold for $10 in 1969 and taken over by a quarry. When Alyce was born in 1973, quarrying had left the land in ruins and the family was renting a little house. Alyce said her mother beat her, so she left Brandywine.

Living in poor areas inside the Beltway, she struggled to make a living, working in a grocery bakery and taking care of the elderly. None of her jobs offered dental insurance, so she and her children went without care. Research showed that the county’s only federally qualified health center could service only a small percentage of the 80,000 uninsured adult residents in 2005 and 2006.

Gentrification of the area caused rents to skyrocket, and families could not find affordable housing. Alyce and her children ended up in a shelter, a simple apartment-style unit, where she received job and substance abuse counseling among other services. When her time allowed in the shelter ran out, she went into a rehabilitation center and her sons were split up among her extended family. Deamonte and his younger brother DaShawn went to live with his grandparents in a mobile home.

Lorrie Norris, a lawyer for Public Justice Center, a Baltimore nonprofit that was surveying the homeless, contacted the Drivers during the summer of 2006. Alyce called Norris later that summer when she needed help finding DaShawn treatment for infected teeth.

The ordeal of finding dentists and actually getting treatment was a nightmare. The Medicaid system has gotten increasing complex, with private companies contracting with the government to offer managed care plans, with subcontractors that administer dental or health benefits, and with defined networks of dentists and other health care providers that accept your particular insurance plan.

Maryland introduced the managed care system in 1997. Once it began, some health departments stopped providing dental services to Medicaid children. In 2000, Maryland gave less dental care to these children than any other state in the nation.

Alyce couldn’t find a dentist who accepted DaShawn’s Medicaid plan. Norris began to sort through the maze of DaShawn’s managed care plan. His health plan was United Healthcare, but dental benefits were administered through Dental Benefits Providers, another company. When Norris called Dental Benefits Providers, a representative told her (1) the Medicaid part of United Healthcare was called Americhoice; (2) DaShawn would have to see a general dentist first to get a referral to a dental surgeon; (3) dentists had contracts with Americhoice (not United); and (4) to make sure providers were contracted with “Americhoice through the state.”

The representative gave Norris a list of participating dentists. The first 26 dentists on the list who were called no longer participated with the dental plan. Norris then called the state’s help line for Medicaid beneficiaries. The first person Norris spoke to could not find DaShawn in their database. A supervisor found DaShawn and transferred Norris to a state health department nurse case manager. During the next five days, Norris, along with the state case manager, a case manager from the county, and an Americhoice employee worked to find participating dentists. At the time, fewer than 20 percent of Maryland’s dentists accepted Medicaid patients.

But finding network dentists to treat DaShawn was only the first hurdle. Next was actually getting the dentists to set timely appointments as DaShawn’s infection raged on. Alyce Driver had contacted Norris for help getting dental care in September 2006. However, DaShawn was not able to get his first dental appointment until October. The dentist referred him to an oral surgeon.

The oral surgeon could not see DaShawn for a consultation until six weeks later and then scheduled the appointment for DaShawn’s teeth to be extracted in December. The dentist’s office called to reschedule for January 16, 2007. Then Alyce had to cancel the appointment because she found out the children’s Medicaid had lapsed January 8. She suspected that the state had sent the information to renew to the wrong address in a bureaucratic mix-up.

Just then, Deamonte became ill with a tooth infection. He kept complaining about a headache, so his grandmother took him to a nearby hospital. Doctors gave him medicine and the next day, Thursday, he went back to school. But Friday he felt worse and couldn’t talk. His mother brought him to another hospital, where he had a spinal tap and CT scan. Doctors said he had meningitis and sent him to Children’s National Medical Center in Washington, DC for brain surgery. The infection came back and Deamonte had a second brain surgery, when his abscessed tooth was finally extracted. But by then, the bacteria from the tooth had reached his brain. Even with two surgeries, doctors were unable to save Deamonte’s life and he died.

It wasn’t until after Deamonte’s death became a widely publicized tragedy that Alyce Driver was able to get DaShawn’s infected teeth extracted.