Revealing How Dentists Profit By Abusing Children

When I walked off the news set after reporting on Small Smiles, a chain of Medicaid dental clinics for children, the makeup artist was sobbing. “How could they?” she said. A producer sitting outside the editing room was in tears. Each was reacting to the wretched screams of children during dental treatments—screams they’d heard as my story aired.

This story about Small Smiles began for me in May 2007. I had returned to WJLA-TV, an ABC affiliate station that I’d left 17 years earlier to do investigative reporting at the networks. The news director, Bill Lord, encouraged me to return to my “local roots” and enthusiastically assured me that there would be time and resources to do the kind of digging that could hold the powerful accountable and make a difference in the Washington, D.C. community. Although I worked on other projects, the Small Smiles investigation became my benchmark.

Like hundreds of other investigations I’ve reported during the past 30 years, this one began by answering a random phone call. Deborah McDaniel, a dental assistant, was enraged. She had just tried to log an official complaint with the Maryland State Board of Dental Examiners against her former employer, Small Smiles, the largest dental chain for children in the country. Incredibly, she said the board wouldn’t allow her to file a complaint because the patients weren’t her children, and she no longer worked there. She’d been fired from the Langley Park, Maryland facility the day before. It was one in a chain of nearly 70 clinics scattered across the country delivering dental care to half a million children annually. McDaniel angrily explained that she was let go for loudly complaining about a dentist drilling teeth on the wrong child. “I’m a mother,” McDaniel vented. “There’s no way I would bring my children there. They tie the little ones down on papoose boards and do unnecessary baby root canals for the bonus money.”

Unnecessary baby root canals? Bonus money? Through her emotional tirade, McDaniel described business tactics that she believed encouraged unnecessary dental work on defenseless children. Profits made while the children suffered.

McDaniel explained that production goals were set each day by corporate headquarters in Colorado. If the dentists exceeded them, the staff received big bonuses. She had no doubt this encouraged thousands of dollars a month in unnecessary work. She told me corporate contests were held among the clinics. Performing the highest number of baby root canals was the goal, because Medicaid reimbursed top dollars for them. The Langley Park Small Smiles clinic won the contest and had a trophy to show for it.

Some of what she told me in that phone call made me skeptical and, because I’ve always valued personal contact with a major source, I wanted to meet McDaniel right away. I asked her to bring whatever documentation she could provide to support her charges. She brought the Small Smiles Policy Manual, a 100-page manifesto of corporate thinking.

This was the critical document, and it certified her credibility. The manual was filled with red flags. Parents weren’t allowed to sit with their children during treatment. Young children were routinely strapped to papoose boards, immobilized with Velcro straps. And she showed me a bonus check for beating production goals while acknowledging that she, like other dental staff, conducted x-rays on children even though they weren’t certified, a clear violation of Maryland law.

McDaniel agreed to speak on camera and, in the course of the interview, she described how some children, isolated from their parents, would sweat profusely. Sometimes they threw up. If that happened, the dental assistants were taught to flip them over on the papoose board, suction out their mouths, and flip them back so the dentist could continue working. Sometimes the children wet their pants. Hair dryers were kept handy to dry kids off before sending them back out to their parents. McDaniel explained that the rooms had radios blasting to obscure the sound of screams.

I wanted corroboration for what sounded like a “Little Shop of Horrors” and, after much agonizing, two more former employees agreed to talk on camera. Others, still on the job, spoke to me on background. Their stories about how children were treated were remarkably similar.

Visually Documenting the Story

Getting video of what we’d learned presented a special challenge. Yet from the beginning my producer, Sandy Bergo, and I knew we needed to get inside the clinic to see the dentists in action. Privacy concerns are always paramount when shooting in medical areas, so we rejected the idea of using hidden cameras. We also knew that Maryland is a “two-party consent” state, requiring agreements from both parties to videotape undercover. There were other obstacles. Releases would be needed from parents for any shooting we did. Many were Hispanic and didn’t speak English. We would need to translate releases into Spanish and gain the trust of parents, and many of them wouldn’t like being publicly identified as being on Medicaid.

As we were figuring out our approach to filming, serendipity intervened. I heard the local Fox station had been invited to the opening ceremony of a new Small Smiles clinic to do a feature story. So we called the clinic and asked, “How about us?” They agreed.

My cameraman and longtime friend, Pete Hakel, a 39-year veteran of WJLA-TV, is disarmingly funny and so nonchalant that he can slip away and shoot most anything without raising alarms. When we went to the clinic, he did just that, and captured crying children strapped to papoose boards, others not properly shielded during x-rays, and a four-year old boy having his nose pinched in an attempt to force open his mouth. These scenes were so graphic that we debated what would be acceptable to show on air. I took my video around to several pediatric dentists to get their reaction. They were shocked, even describing what they saw as “torture.” I was told papoose boards are rarely used, and some pediatric dentists don’t even own one because they know how to keep children calm.

McDaniel had told us about the morning staff meeting during which the staff was briefed on the day’s production goals. She described them as pep rallies. So on our second day of shooting, Pete arrived two hours early and, incredibly, was allowed to roll tape on the lead dentist chastising the staff for not meeting the previous day’s production goals. When I interviewed the lead dentist, he candidly admitted that their team sometimes would do six or more baby root canals on a child in one sitting. I already knew the clinic would be reimbursed $214 in public Medicaid funding for each one.

What Happened Next

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Read the script and see the video of this story »
– www.wjla.comOur news director prefers that investigative reports are told in fewer than three minutes, but our first report on this story aired at a full eight minutes. The report’s length—and its disturbing content—created a sense of urgency. The impact of our “Drilling for Dollars” investigation was broad and swift. I’d alerted the inspector general at the federal Department of Health and Human Services, who subsequently opened an investigation that is still in progress. Maryland’s attorney general began a criminal investigation. And by the end of the first week, half a dozen insurance companies put the Small Smiles clinics in Maryland and the District of Columbia off-limits to their patients while they conducted their own investigations. Ultimately, the Langley Park Small Smiles clinic shut down. Small Smiles also launched an internal investigation and, although they would not agree to be interviewed on camera, the company claimed to have made improvements that included ending contests for clinics that exceeded production goals.

EDITOR’S NOTE
The Washington Post reported this story on February 28, 2007 in a story, “For Want of a Dentist.” How was it that Small Smiles could be so profitable just treating Medicaid children? Earlier in 2007, a 12-year old Maryland boy died from untreated tooth decay. The infection traveled to his brain, causing an abscess. In the aftermath of his death, a shocking statistic had emerged. Four out of five dentists refuse to treat Medicaid children because it’s just not profitable enough. Government reimbursement rates are far less than what private insurers pay. Small Smiles made up for that in volume by maximizing the amount of work they could do per visit. This strategy proved to be so profitable that the company’s goal was to continue opening three new clinics every month. As I dug more deeply into the finances of the company, I discovered The Carlyle Group was a major investor along with an Arab bank in Bahrain called Arcapita, which invested $460 million in the enterprise.

We did a dozen Small Smiles follow-up reports during the next year; in some of those, I identified similar problems across the country. Our efforts earned the Scripps Howard Foundation National Journalism Award and a local and national Emmy for investigative reporting. In January of this year, we were given an Alfred I. duPont-Columbia University Award, one of the highest honors in broadcast journalism.

But this winter has been bittersweet. WJLA-TV decided to shut down the investigative unit—and thus end my job at the station. The station’s owners described such reporting as “a luxury” they can no longer afford.

I disagree. Is it a luxury when our reports convince companies to reform bad business practices? Is it a luxury when regulatory agencies suddenly are motivated to enforce laws already on their books? And is it a luxury when the most vulnerable among us, those without access to power—like the children at these dental clinics who are victims of corporate greed—are given an opportunity to be heard?

My reporting has led to recalls of dangerous products, banned hazardous chemicals, put people in prison, and resulted in congressional hearings and changes in law. It is work that takes time and demands resources, but it pays long-term dividends as news organizations earn the trust of viewers who realize their well being is valued. Investigative reporting should not be part of the equation when determining a news organization’s bottom line. But there’s plenty of evidence—and not just at local TV stations—that these dividends are being sacrificed in favor of short-term profits.

As for me, I’ve been a muckraking journalist for 30 years, and I’m not about to stop. I’ll continue to tell stories that need to be told, possibly on television and on other emerging platforms. I’ll also continue to help other reporters succeed with their investigations by offering research, resources, contacts and strategy, as well as my active involvement with many journalism organizations. It’s incumbent on all of us to explore creative ways to strengthen essential, in-depth watchdog reporting by developing fresh revenue streams that bypass the current broken business model. For more than two centuries, the work by members of the free press to hold those with power accountable has stood as one of the pillars of our democracy. When did that become a luxury?

Roberta Baskin, a 2002 Nieman Fellow, has won more than 75 journalism awards and serves on the boards of the Journalism & Women Symposium, Images & Voices of Hope, International Communications Forum-America, the Robert F. Kennedy Journalism Awards Committee, and the Nieman Foundation’s Advisory Board. “Drilling for Dollars” won a 2009 Alfred I. duPont-Columbia University Award.