I-Team: Small Smiles
posted 11:15 pm Mon November 05, 2007 -
TONIGHT - AN ABC-7 NEWS I TEAM INVESTIGATION.
YOU MIGHT REMEMBER THE STORY OF THE 12-YEAR OLD MARYLAND BOY, DEAMONTE DRIVER. HE DIED FROM A BRAIN INFECTION CAUSED BY TOOTH DECAY… WHICH IS THE MOST UNTREATED OF ALL CHILDREN'S DISEASES.
NOW … A FIVE -MONTH INVESTIGATION BY THE I-TEAM'S ROBERTA BASKIN REVEALS THAT CHILDREN ON MEDICAID WHO VISIT TWO WASHINGTON AREA CLINICS - ARE SUFFERING PAIN FOR PROFIT.
WHAT WE SAW AND HEARD IS DIFFICULT TO IMAGINE. FRIGHTENED CHILDREN SEPARATED FROM THEIR PARENTS… CRYING FOR THEIR MOTHERS WHILE STRAPPED INTO RESTRAINING DEVICES. IT'S A MEDICAID GOLDMINE… AND THEY'RE DRILLING FOR YOUR TAX DOLLARS.
Story: That's 4-year old Miguel. He's been restrained by his dentist on a device called a papoose board.
And Miguel's mother isn't allowed to watch. That's the policy at Small Smiles.
Dr. Aldred Williams: "Not that we are doing anything wrong. But as a parent you wouldn't want to see your child strapped up like that."
Dr. Aldred Williams manages Small Smiles clinics in Langley Park, Maryland and the District. He says they use papoose boards on small children about half the time.
Roberta: "Is part of it so you can get them in and get them out quickly?"
Dr. Aldred Williams: "Yes, that would be part of it, because, you could potentially spend two hours on a kid who's not stabilized and moving around. That's not cost productive for us."
More than a dozen dentists we surveyed said papoose boards are rarely, if ever, used.
Dr. Ronald Starr: "I have never used a papoose board." Roberta: Never? Starr: Never.
Now watch how the dentist gets Miguel to open his mouth. She pinches his nostrils, forcing his mouth open. A practice most dentists abandoned years ago. Roberta: "Is that an acceptable treatment?"
Dr. Williams: "No, I don't personally use it. But some dentists do."
Dr. Thomas Kim is a pediatric dentist.
Roberta: "She's holding his nose shut to get his mouth open."
Dr. Kim: "That's not acceptable. They can do this because their parents not present in this room."
At Small Smiles parents are NOT allowed to stay with their child. They are told they must stay in the lobby. And the sign says it's because of federal "patient privacy" regulations.
Dr. Aldred Williams: "If you can imagine a clinic seeing 80, 85 patients in a day, and all of their parents are back, roaming around all over the clinic. It is a violation."
But in fact no such regulations exist. Small Smiles is doing a business most dentists won't…treating children on Medicaid. The government reimburses less for dental care than private insurance. But Small Smiles makes up for it on volume.
Dr. Aldred Williams: "In fact, we've submitted so many claims to one particular management care organization that they threw up the white flag and said, "Okay, you don't have to preauthorize anything. Just do the work. So we flooded the system."
There are 63 of these Small Smiles clinics across the country. With nearly three new ones opening every month. They're all managed by a company named FORBA - "for better access." Dentists and staff are sent to their Colorado offices for training.
TV AD: "Our trained professionals make kids feel safe and comfortable."
But none of the Maryland, Virginia, or District clinics has a single trained pediatric dentist on staff.
Former Small Smiles dental assistant, Deborah McDaniel, says she was fired for objecting to the way children were being handled.
Deborah McDaniel: "They wanted us to tell parents that they needed services on teeth that were healthy. And they were healthy and they didn't need it." Others say they quit because Small Smiles promotes profit over compassion.
Former Dental Assistant: "The bonus range from $500 to $1500 a month. Baskin: "That's a lot of money. McDaniel: That's a lot of money. And to me, that's like hush money."
The I-Team learned there's a bonus system for "converting" patients from a check-up to major procedures on the same day.
Trina: "It's a competition throughout the country. To see who can convert the most patients. Not give the patients the most care. Get them in that back
operating room with as many baby root canals or crowns, as possible."
"That's all you hear through the office is bonus, bonus, bonus. "The more crowns we put on, the bigger our bonuses."
Dr. Aldred Williams: "...a ridiculous production of $7,000. We can't stay in business making $7,000."
Every morning Dr. Williams and his staff review the production goals set by the managers in Colorado.
Dr. Aldred Williams: "The most glaring statistic Sunday is we only converted two patients. And out of 35, if we only convert two, then we're setting ourselves up for failure. I don't want Langley Park to be the laughing stock of the Small Smiles nation."
Dr. Williams says too often Medicaid patients break appointments which is why they do as much work as possible. Including baby root canals and crowns, which he calls a Small Smiles specialty. Dr. Williams estimates one in three patients needs the procedure.
Up to how many crowns can you do in a setting? Dr. Williams: "We can do 5 to 6 crowns." Roberta: "In one sitting?" Dr. Williams.: "In one sitting, yeah." Roberta: "Even more than that?" Dr. Williams: "Even more than that sometimes."
Dr. Robert Camps is a nationally recognized authority on pediatric dentistry. Most of his practice in Frederick Md. is also on Medicaid. Dr. Camps worries that Small Smiles does baby root canals when simple fillings would work.
Dr. Robert Camps: "It does no good for anybody but the dentist, I guess, who's looking for a bonus."
Trina: "It got to the point where the dentists would even compete with the other dentists of how much crowns and work they did a day."
(Graphic) The clinic here gets $214 tax dollars for every baby root canal and crown it bills. It adds up. Here's a $600 bonus check.
Roberta: "Now, I understand there was a contest for conversions and that you won here, that Langley Park."
Dr. Williams: Langley Park won. Roberta: What did you win? Dr. Williams: A trophy. Roberta: For doing conversions? Dr. Williams: Yes. Roberta: And bonuses? Dr. Williams: Yeah, there was a bonus, too.
Trina Crosby says multiple procedures can be traumatic for small children.
Trina Crosby: "They're sweating. Sometimes they urinate on themselves. They throw up. They teach us how to turn them to the side, suction the throw up out. Flip them back over. Because mind you, they're still strapped down."
Former dental assistants also say they routinely took x-rays they were not certified to do.
Trina Crosby: Yes, constantly, daily basis. Roberta: Are you certified in Maryland to give x-rays? Trina: No, I'm not.
Roberta: When you look at that video, that adolescent, is she properly shielded? Dr. Robert Camps: Absolutely not!
We showed Dr. Camps all of the video of 4-year old Miguel.
Dr. Robert Camps: "Obviously, that's unethical. I mean, by anybody's standards, it's just unethical. It's traumatic for me to watch. I can only imagine how traumatic it is for Miguel."
Miguel's mother brought her son to Dr. Camps for follow up care. And when Small Smiles refused to release the x-rays to his mother, Dr. Camps intervened.
Dr. Robert Camps: "They did not take the x-rays of the back teeth where they actually did treatment."
And there for the first time, this mother got to witness her son's treatment at Small Smiles.
Ana Mejia reaction
But despite the assembly-line feel at Small Smiles, Dr. Williams insists they're providing a vital service to children, who often don't get regular check-ups, and generally need more treatments.
Dr. Williams: We aggressively treat these children to eliminate disease in their mouth. Small Smiles makes no apologies for that. I'm not going to apologize for being aggressive."
Dr. Camps says no one doubts the need for care… but at what cost to these vulnerable children?
The company that manages the Small Smiles clinics (FORBA) says its audits show all the work they perform is needed and that parents are informed and give their consent every step of the way.
We hope you'll go to our Website to give us your feedback. You'll find more information there including a special hotline number set up by the Medicaid Inspector General's office.
And finally this was a very difficult process for many of the people who worked at this clinic.
Many of them reported that children suffered VERBAL abuse during their dental visits.
Comments like telling a child "IF YOU'RE NOT GOOD, I'LL GO GET THE BAD DOCTOR."
To See the 11 p.m. Version Of Story: CLICK HERE
Questions About Dentistry Or To Find A Dentist: CLICK HERE
To Register A Complaint: CLICK HERE
To view extended interviews: CLICK HERE
CLICK ON THE MAP BELOW TO SEE ALL THE SMALL SMILES LOCATIONS ACROSS THE COUNTRY:
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