Cavity Depravity

The rotten roots of a sweet HMO deal rip dental health from the mouths of babes

Elise Linder, program manager of Community Voices Miami, advocates for oral health access. She says the current Medicaid program is already problematic because although many people qualify, reimbursements to dentists are so unremunerative, there aren't many willing to accept Medicaid. "If the legislature is doing to oral care what they're doing to Medicaid and KidCare in general, it's pretty scary," she warns.

Healthcare exec Michael Fernandez is a principal in Atlantic Dental; among the other companies he owns is CarePlus Medical Centers, Inc. HMOs have been good to Fernandez. Early this year he spent $26.8 million to buy a home and waterfront property in Gables Estates. He's also been magnanimous to his friends, giving enormous amounts of money to many politicians through his various companies. Last year, his generosity embarrassed Alex Penelas, county mayor and Senate hopeful, when an e-mail a Fernandez associate sent out compelling employees to donate to the Penelas campaign became public. A Miami Herald analysis later found that Penelas took at least $68,000 from the company's employees, their relatives, and business associates.

Fernandez also served as vice chair for Penelas's Sixth Annual Mayor's Ball, a charity schmoozefest held on a cruise ship in December 2002. Atlantic Dental was an event sponsor. Fernandez was appointed to a county task force created by Penelas to study ways to improve healthcare access for the poor, in part by using private providers.

Dr. Luisa Utset-Ward believes there'll be more poor 
kids with bad teeth if an HMO takes over their Medicaid 
dental benefits
Jonathan Postal
Dr. Luisa Utset-Ward believes there'll be more poor kids with bad teeth if an HMO takes over their Medicaid dental benefits

But Fernandez has been generous to other politicians as well. Last year, the Republican Party of Florida got a $25,000 check from Healthcare Atlantic Inc., an affiliated company run by Atlantic Dental CEO Leila Chang. And he keeps state Rep. Rene Garcia in kibble by employing him as an "outreach coordinator" for CAC Careplus (and before that Physicians Healthcare Plans, Inc., a company Fernandez sold in 2002). Garcia sits on the House subcommittee on health services, the subcommittee on health appropriations, and the select committee on affordable healthcare for Floridians. And he sat in on the conference committee between the House and the Senate, during which the amendment was inserted. Garcia asserts that he had nothing to do with the amendment, noting that the original legislative mandate for a pilot project was approved in 2001, before he worked for Fernandez.

A five-year-old with her front teeth eaten away almost to the gumline and a nasty abscess just above them lies back in rigid terror against the vinyl chair. Her numerous black braids with clear beads on the ends dangle onto a white and pink flowered T-shirt that says, ironically, "Sweet."

"It hurts!" she cries, twisting her body so that her white sandals knock against each other.

"I know some of your teeth hurt," Dr. Luisa replies, rubbing a cherry-flavored gel on the girl's gums before numbing them with an injection. "I'm going to make it better."

With swift efficiency and a distracting banter, the doctor pulls out two front teeth with miniature pliers. Fresh screams fill the office.

"Okay, Mommy got you," the girl's mother soothes. A four-year-old boy in the next chair weeps in silent anticipation. His mother wipes his face.

"Her teeth gonna grow back?" the girl's mother asks, tapping a pink bedroom slipper lightly against the floor.

"Yes," Dr. Luisa answers sternly, smoothing a bright sticker onto the girl's shirt. "but not until she's about seven. This isn't her fault, as much as you don't want to hear that."

Mother and daughter are sent off with a new toothbrush and an appointment to have more teeth removed next week. Utset-Ward says baby bottle syndrome is common among poor children because their parents often don't know that it's not good to let them constantly sip juice or milk. The result, without proper brushing and dentist appointments, is numerous cavities. "I see kids like this four, five times a day," she laments. "This girl will be okay, but younger kids who lose their teeth while they're learning to speak can end up with a speech impediment."

Other drawbacks for children with too many rotten teeth are the risk of developing an infection that could send them to the hospital, and malnutrition because it hurts to eat.

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