A Dearth of Prevention

Deamonte Driver shows the scars from his brain surgery. His mother, Alyce, is at his side. Linda Davidson/The Washington Post

Mary C. Otto was a reporter for The Washington Post when she wrote this piece for the Journalism Center in 2007. Otto is now Editor-in-Chief for Street Sense, a Washington, D.C.-based 16-page biweekly street newspaper that was founded in 2003. Its mission is to raise public awareness on the issues of homelessness and poverty in the city and to create economic opportunities for people experiencing homelessness.

By Mary Otto, reporter, The Washington Post, March 3, 2007           

Deamonte Driver, 12, had a long row of stitches running across the top of his head when I met him at Children's National Medical Center in Washington. The homeless seventh grader spoke haltingly, his Deamonte Drivermother close at his side. Deamonte had undergone two emergency brain surgeries two weeks before -- after an infection from an abscessed tooth had spread to his brain.

Deamonte Driver shows the scars from his brain surgery. His mother, Alyce, is at his side.

His exhausted family had prayed him through what they hoped was the worst of the crisis and his mother, Alyce, had agreed to talk about their ordeal. As a Maryland reporter covering poverty for the last few years, I am always grateful to people who will let me into their lives and share their stories. Whether their journey has included addiction or homelessness, the lack of transportation or health insurance, their experiences can help me -- and our readers -- get a better understanding of the true meaning and cost of living in poverty.

I learned about the Drivers’ travails through lawyer Laurie Norris, of the Baltimore-based Public Justice Center. Deamonte, like many poor children, had rarely seen a dentist, with terrible results. Children with Medicaid coverage often have difficulties finding dental care, especially for cavity fillings and other restorative treatments. At the time Deamonte got sick, the family had temporarily lost Medicaid coverage. In fact, until her older son was being rushed to the hospital, Alyce Driver was focused on getting services for Deamonte's younger brother, who had six abscessed teeth.

In my reporting, I learned that fewer than one-third of children covered by Medicaid in Maryland in 2005 (most recent data) received any dental treatment at all.The figures were even grimmer in nearby Washington D.C. and Virginia. I found a system broken on several levels: Many dentists refuse to accept Medicaid patients, citing low reimbursement rates, layers of bureaucracy and the challenges of working with indigent families. (A leader of the Maryland State Dental Association estimates that about 900 of the state's 5,500 dentists see Medicaid patients. (See a list of associations here.) Referring patients to specialists can be particularly difficult. Yet state officials and the Drivers' Medicaid provider said they had worked to assure the family's access to care.

The story revealed the false economy of stinting on routine dental care for poor children. For a lack of regular checkups and an $80 extraction, Deamonte would need more than $250,000 worth of surgery and care in roughly two weeks at Children’s Hospital. Then he was expected to have six weeks of physical and occupational therapy, medical treatment and tutoring at another hospital.

In between other assignments, I continued to work on the story and stayed in touch with Alyce Driver. After I filed, the story sat on the Metro budget for a week and then some, caught in the daily crush of stories about traffic and government, crime and education.  

Finally, on the evening of Monday, Feb. 26, the copy desk called. My story was scheduled to run the next morning. I told the copy editor that I hadn’t spoken to Demonte's mother for a couple of days and I wanted to call and check on his progress.

Alyce Driver’s voice on the telephone was barely a whisper.  

“Deamonte...he perished,” she said.   

After spending an apparently happy Saturday in the hospital with his mother and friends, playing cards and watching television, the boy had died on Sunday, from conditions associated with brain infection. Alyce Driver’s voice was so weak that I felt terrible continuing the conversation, and I arranged to call back the next day. I numbly called the copy desk to get the story held, and called my editor, Phyllis Jordan, to let her know. I went to visit Alyce Driver the next morning and worked all afternoon to rewrite.  

“Twelve-year-old Deamonte Driver died of a toothache Sunday” was the new lede of the story that ran in Metro on Wednesday, Feb. 28, under a haunting photograph of Deamonte taken by my colleague, staff photographer Linda Davidson.   

The reaction was swift and stunning. Local, national and even international news picked up the story. Torrents of e-mails -from as far away as Australia came in from readers. Some offered help and expressions of sympathy for the family. Some described their own struggles with access to care.    Others leveled attacks on me and the rest of the “pansyass liberal” press for writing about poor people who -- it seemed clear -- were wholly responsible for their own misfortunes.

“You are an idiot,” offered one reader. Others weighed in with swift and summary judgments on Alyce Driver’s character and fitness as a parent as in: “Why didn’t she buy a toothbrush instead of a lottery ticket?”

Yet others called for reform in the system that provides dental care to the poor here and across the country. These last letters came from individual readers, some of them health professionals, and from elected officials too.  

In a followup story I wrote with the help of colleagues in the statehouse, Maryland legislators were quoted as saying Deamonte’s death added new urgency to their efforts to pass a bill that would provide increased funding for clinics in areas where dental care is hard to find.  

And on the floor of the U.S. Senate, only a few miles from where Deamonte died, Maryland Sen. Ben Cardin and New Mexico Sen. Jeff Bingaman invoked Deamonte’s name as they introduced The Children’s Dental Health Improvement Act of 2007, which would provide millions of federal dollars to increase care for poor people and reimbursement rates for the dentists who care for them.  

It was exciting to write that followup story, though I could not forget the tragedy that led to it. After I filed, I stopped by to see Alyce Driver and to pick up the handwritten death notice she wrote for her son. I promised to deliver it to the obituary desk that night.  

“Deamonte Thomas Driver...age 12.... loving son of Alyce Driver....”

For data, contact the federal Centers for Medicare and Medicaid Services; they also publish a list of SCHIP dental health contacts by state. You can also the individual state SCHIP/Medicaid Web sites , as well as the CDC's research on the prevalence of tooth decay among children, which affects children in the U.S. more than any other infectious disease.

Read Otto's Washington Post article,"A Dearth of Prevention," in full.