Thanks to Poynter's Online
An Investigation
WJLA-TV investigative reporter Roberta Baskin aired a story Monday night about the nation's largest chain of for-profit dental clinics. With 66 clinics nationwide, Small Smiles makes a good living off Medicaid. (Watch the story. Warning: It is hard to watch.)
WJLA said it found x-ray technicians who were not licensed to perform the work they were doing, and the station said young children were sometimes children-strapped to "papoose boards" that kept the kids immobile during uncomfortable procedures that their parents were not allowed to witness.
The station said the clinics also quoted former clinic workers who said they were pressured to push baby root canals as treatment because such treatments are lucrative.
I interviewed Baskin via e-mail to learn more about the investigation:
 Roberta Baskin |
A. It began with picking up the phone and listening to a random caller. She was a dental assistant who said she'd been fired for complaining about how her clinic treated Medicaid kids. She went on to describe a bonus system, with daily financial goals, which she believed provided an incentive to do unnecessary procedures for more Medicaid money. At first she complained to the Maryland inspector general's office overseeing Medicaid. But they referred her to the Better Business Bureau. That riled her enough to call WJLA.
Q. What surprised you the most?
A. It surprised me most that the small policy clinics have a policy to separate children from their parents and say it's a privacy regulation under the Health Insurance Portability and Accountability Act (HIPAA). It surprised me even more that they let our cameras in the back, when they wouldn't allow parents in. It also surprised us how much access we got and how much video we were allowed to shoot of questionable practices. The dental staff is so used to doing what they're doing that they didn't seem to think there was anything unusual about their treatment of Medicaid families. It's just the way those Small Smiles clinics we videotaped do business.
Q. How did you get access to patients?
A. We brought patient consent forms in English and Spanish and asked for permission. Some families said yes, others declined.
Q. How were you able to prove the story to be true, given that you are dealing with HIPAA, Medicaid and medical board oversight?
A. It's a complex system. In addition, there are managed care agencies between the clinics and the state, each with their own rules of engagement. We interviewed more than 100 people: dentists, associations, dental boards, inspectors general, Medicaid, dental assistants, on and on. There are other former employees of Small Smiles we interviewed who were afraid to go on camera, but their stories laid out the same issues.
Q. Just the topic of dentistry, little kids getting root canals and being tied up in "papoose boards" all sounds disturbing. Did you have any concerns that people wouldn't watch it?
A. Yes. It's not a pretty subject. A newsroom employee outside editing was in tears just listening to the children cry. Another production staffer was sobbing after seeing it. We had an extraordinary response in e-mails and calls from viewers. Most were angry at the practices, some were upset by what they saw. And yes, a few were angry at me. We needed to show what we saw so people would see what they otherwise couldn't. We also made an effort not to show shots in the mouth or too many faces. The photojournalist purposefully shot Miguel's feet because that told a lot of the story.
Q. What did you learn when investigating this story that other journalists should know?
A. The most important stories are always the hardest. This one was a challenge on many levels. But tenacity and patience eventually pay off. Also, you don't have to shoot on hidden camera. Going through the front door is always best. A child had died in Maryland from a brain infection caused by untreated tooth decay. It highlighted the fact that four out of five dentists refuse to take Medicaid kids. Small Smiles has a business model that exclusively handles those kids. We just asked to see how they do it.
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