AMERICA IS A RACIST NATION
Coronavirus layoffs disproportionately hurt black and Latino workers: 'It’s almost like doomsday is coming'

Deborah Barfield Berry USA TODAY 3/24/2020

WASHINGTON – Opal Foster went to work last Wednesday at a small printing company in Rockville, Maryland. By lunchtime, the graphic designer had been laid off.

The company’s main customers – private schools, entertainment venues and national museums – had closed because of the coronavirus outbreak, so business had nearly come to a halt.

The single mother, who has a son with Down syndrome, will rely on some freelancing to help make ends meet and turn to family and area food banks to help fill her cupboards.

“For the short-term, that’s the Band-Aid on the wound,” said Foster, 45, who is African American. “But that doesn’t pay my car note. That doesn’t pay my rent.”

Foster is among thousands of employees at small businesses, restaurants, hotels, bars and manufacturing companies who lost their jobs in recent days because of the pandemic. Civil rights groups worry those workers, many of whom are people of color, will be sent in a downward spiral, scraping to pay bills and feed their families.


“We know that when the economy goes into decline, people of color always bear the brunt,’’ said Teresa Candori, communications director for the National Urban League. “We will be fighting to make sure the most vulnerable communities are not an afterthought.”

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It's unclear if Washington's recovery plans will go far enough to get these workers through the hardship. National lawmakers are at odds over what to include in Congress' latest stimulus bill aimed at providing relief for workers and businesses hit hard by the outbreak. Republicans and Democrats differ over some key provisions, including the length of time for unemployment benefits and issues like funding for food stamps.

National civil rights leaders have called for a meeting with congressional leaders to push for more help for low-income workers, who are disproportionately brown and black people. Those groups historically have been overlooked or left behind by the federal government during major crises, said Melanie Campbell, president of the National Coalition on Black Civic Participation.

She called the coronavirus “an equal-opportunity pandemic.’’

“If you think about (Hurricane) Katrina, if you think about other catastrophes, a lot of times bailouts ended up taking care of the top and then it trickles down to the people,’’ Campbell said. “Our federal government has to be bold about responses as this is an ever-evolving pandemic that can become a real catastrophe for people's daily lives.”

Many blacks, Latinos, Native Americans and other communities of color saw their household wealth decline during the 2008 Great Recession and have yet to fully recover, raising questions about whether the latest financial downturn will set them back even further. The median wealth of middle-class black people dropped to $33,600 in 2013, down 47% from before the recession. For Hispanics, median wealth fell to $38,900, a 55% decline since 2007. White families saw their median wealth decline by 31% to $131,900, according to the Pew Research Center.

Census 2020:Coronavirus could make it harder to count Americans

Graphic explainer:Congress' $2 trillion coronavirus stimulus package

'It’s almost like doomsday is coming'

For some small business owners, the pandemic has meant shutting down because of local restrictions, or losing customers afraid of going about their normal routine.

On a recent afternoon, the smell of spices welcomed visitors as they walked into The Spice Suite, a quaint shop in Washington, D.C. Small glass bottles of spices lined the shelves. Olive oils in silver dispensers were stacked along one wall. Customers Janel Jackson and Kashmiere Apollon, both regulars, sniffed spices and lined them up at the cash register

A Costco-size bottle of Germ-X rested on the edge of a table at the front of the store. Apollon pressed down on the pump, squirting the sanitizer int her hands. She had heard the store would temporarily close that day.

“It’s going to be terrible,’’ she said. “So many people frequent this place.”

Angel Gregorio, the boutique's owner, had made the tough decision the night before to close for at least two months. Gregorio opened the store five years ago and won a $50,000 grant from the city last year to renovate. That work had recently been completed.

Gregorio, who is black, said uncertainly and fear of the spread of coronavirus has kept many of her customers away.

“What we’ve noticed is that folks are just not sure, just generally, about whether to leave'' their homes, Gregorio said. “And then coming to get spices, it’s like ‘I used to come out specifically for the Spice Suite but since I’m in the grocery store and been in this line for two hours, I may as well just get these big-box brands while I’m here.’"

Still, she’s grateful for loyal customers who came to shop in recent days. “It’s almost like doomsday is coming, and everyone just wants to get what they can until we get further notice about how to proceed,” she said.

Gregorio said small businesses like hers will need financial aid from federal, state and local governments to help recover and make “our employees whole.”

Closing the store has a ripple effect.

Lynette Jefferies, owner of My Desserts Diva, sells her baked goods, including peach pound cake and sweet potato tarts, out of Spice Suites. She’s among the 20 black women who sell their goods at the shop.

Jefferies said this would probably be her last time sellingdesserts in person for a while. She plans to focus on online sales and take advantage of the time shut indoors to work on an e-cookbook.

“It hurts a lot,’’ she said. “This is my livelihood. This is how I pay my bills.’’

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'I'm heartbroken'

Other small-business owners weren't sure whether they should close their doors and start letting workers go.

Kookie Park spent the weekend weighing whether to open her cafe in downtown Washington, D.C., this week. With many of her regulars working from home because of the coronavirus, the number of customers coming to buy fried chicken wings, fried fish and other popular items off the hot buffet has dropped from about 600 a day to barely 100 by the end of last week.

“Day by day, and I'm losing more people because now people are not coming to work,’’ said Park, who along with her husband, Dae Kim, owns the Cornerstone Cafe.

There was much less food to prepare, so only half of Park’s eight workers were called into work. With nearby hotels expected to shut down, she expects ever fewer customers.

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Park plans to pay her workers, all of whom are Latinos, for at least the next two weeks. After that, she’s not sure.

“I'm heartbroken,’’ said Park, who is Korean American. “I mean, I have to pay rent myself, too, so I'm worried about that, too. But as a boss, I want to take care of them because they've been working with me such a long time and I want to go through this hard time together. ... They have their own families, so it's kind of hard for them, too.''

Park is hoping the city will help small businesses like hers and Congress will step up with aid. The last time the cafe suffered was when the federal government shutdown in 2018. That was a long 35 days, but it wasn’t like this.

“This time, I'm not sure,’’ she said. “I don't know because nobody knows.”

Many people can't work from home

Experts said it’s unclear how many jobs will be lost because of the outbreak. But many who have already lost their jobs and who could lose their jobs soon include service workers and other jobs that are disproportionately done by people of color, they said.

The number of people filing for unemployment benefits increased last week by 70,000 to 281,000, according to a Labor Department report. It attributed the initial jump to COVID-19 and cited layoffs in various fields, including hotel and restaurants.

Many people of color are in jobs that don’t have the option of working at home, said Danyelle Solomon, vice president of Race and Ethnicity Policy at Center for American Progress.

“You can't really work from home if you're waiting tables, cooking, taking care of folks as a home aide, or the health care workers who are in the hospitals right now,’’ said Solomon, co-author of a report released last week on the pandemic and its impact on the racial wealth gap.

According to the CAP report, 16% of Latino workers and 20% of black workers are able to work from home, compared with 30% of white workers.

The report also found that black, Asians and Latinos are overrepresented in typically low-paying jobs in the restaurant and hotel fields. Nearly 14% of workers in the accommodation and food services fields are Vlack and 27% are Latino, according to the U.S. Bureau of Labor statistics.




A case for increasing current jobless benefits:We helped jobless workers survive the Great Recession. Here's what to do on coronavirus.

Those jobs often don’t offer comprehensive health care and other benefits, such as 401(k) and paid sick leave, Solomon said.

“People of color were not sitting in the best economic situation to begin with and this pandemic is only going to exacerbate that problem,’’ she said.

She said those workers can't respond to "economic shocks," whether it's dealing with a flat tire or losing a job because of a pandemic.

"It's much harder for you to weather that storm if you don't have those extra resources that folks with wealth have," she said.

Communities of color were particularly hard-hit during the 2008 recession, and some are still struggling from that, said Shaomeng Jia, an economics professor at Alabama State University.

People at an economic disadvantage are “already not doing so great in a good day, let alone in a rainy day,’’ he said.

Jose Ricardo is already bracing to dip into his savings to pay next month’s bills for his mobile home in Chula Vista, California. Ricardo, a waiter at a Japanese restaurant in San Diego, is working only 16 hours a week, down from the usual 32 hours two weeks ago.

“I’m really nervous,’’ said Ricardo, 61. “We are used to working hard.”

With new restrictions on restaurants to serve takeout only, Richardo no longer has the extra income from tips. He makes $12 an hour.

“People pay tips because they get a service. We’re taking care of them,’’ he said. “Now, with takeout, they pick it up and bye-bye.”


Ricardo, who lives with his wife, mother-in-law and two children, said he’s anxiously waiting to see how lawmakers will help him and other workers. But he’s worried about his co-workers, who are undocumented and won’t get that help.

Still, he’s holding out hope. “We will recover for sure,” he said.

In Native American lands, the economic pains of the coronavirus has been felt as fewer tourists visit, forcing the closures of some restaurants, museums, cultural centers and gaming operations, said Kevin Allis, head of the National Congress of American Indians.

“Not only do the businesses shut down, no longer providing income for tribal governments to run its programs, almost all the employees are tribal members,’’ said Allis of the Forest County Potawatomi community in Wisconsin. “So when these places shut down, not only now does the government have no more money coming to it, it experiences an enormous unemployment rate that further cripples and has a catastrophic effect on these particular communities.”

'You can only find jobs if they're there'

Foster, who was recently laid off from the small printing company, plans to post her resume online but is sure that because of the outbreak, many companies won’t be conducting in-person interviews until at least May. That’s if they’re hiring at all.

“You can only find jobs if they are there,” said Foster, who lives in Silver Spring, Maryland. “I’ll keep trying.”

Though her now former boss promised to put her and others back to work when the economy starts up again, Foster said she needs a salary now.

A day after being laid off, she hurried to get her root canal – two of them – before her benefits run out at the end of the month.

Meanwhile, she’s putting on hold plans to take her son, Jeremiah, to Legoland in Florida this summer. It would have been their first “true’’ vacation, she said. The amusement park might not even be open by then – plus, she said, she has to stretch the little savings she has.

“We didn’t have a whole lot extra, but we were making it,’’ she said. “Ironically, we were just kind of getting on track when the rug was pulled out from under us.”

Contributing: Nichelle Smith

A RECESSION IS WHEN YOU LOSE YOUR JOB A DEPRESSION IS WHEN I LOSE MINE

Pakistani women walk past vendors selling face masks to prevent the spread of the coronavirus, in Peshawar, Pakistan, March 24, 2020. Pakistani authorities said they'd shut down train operations across the country from Wednesday until March 31 in an effort to contain the spread of the virus.  MUHAMMAD SAJJAD, AP

USA Dentists under pressure to drill ‘healthy teeth’ for profit, former insiders allege

David Heath, USA TODAY, Mark Greenblatt and Aysha Bagchi, Newsy
 Mar. 19, 2020

Johannah Lancaster took her 3-year-old son to Dental Express for his first checkup, expecting a routine cleaning.

She never imagined the treatment plan the Niles, Ohio, dentist would come up with after he peeked into Gregory’s mouth for what seemed like only two or three minutes.

Michael Griesmer said the preschooler needed root canals – seven of them. Stunned, Lancaster asked why he had not even taken X-rays. Griesmer told her they weren't necessary.

“I figured he is a professional so I trusted him,” she recalls. “If I knew then what I know now, I would have never gone through with any of it.”

Two weeks later, in May 2013, the dentist put Gregory under and drilled his teeth. The Medicaid bill came to $1,273 – compared to the $61 that Medicaid would have paid for a checkup and cleaning.

What Lancaster didn’t know then: Dental Express was part of North American Dental Group, a chain backed by private-equity investors. At least a year earlier, the company had told dentists like Griesmer to meet aggressive revenue targets or risk being kicked out of the chain. Those targets ratcheted up pressure to find problems that might not even exist.

Johannah Lancaster's son, Gregory, now 9, received seven root canals at a dental clinic when he was 3. The dentist never took X-rays and Gregory later had to have four of the teeth pulled.JEFF SWENSEN, FOR USA TODAY

“The 3-year-old boy was subjected to massive overtreatment,” said Nicholas Dello Russo, a dentist and instructor at Harvard University’s dental school who reviewed Gregory’s records. “This is child abuse.”

North American Dental Group follows a new trend of dental offices bought by private-equity investors and turned into revenue-generating machines. The chain started in Ohio and soon became among the fastest expanding. It now has more than 200 offices in 13 states east of the Rockies, handling a million patient visits a year. Late last year it was bought by a Swiss firm that also owns hundreds of dental offices in Europe.

While any dentist might be tempted to find ways to increase profit, private-equity firms often saddle their companies with heavy debt at junk-bond-caliber interest rates. That may leave patients vulnerable, critics warn.


North American Dental Group has become a lightning rod for complaints in recent years, especially from former dentists and employees who say revenue pressures went far beyond what is typical in the industry.

USA TODAY and the investigative unit at Newsy, owned by The E. W. Scripps Company, spent more than a year examining the dental chain. Reporters interviewed dozens of its former dentists, employees and patients and reviewed thousands of pages of documents from courts, dental boards, patient records, social media reviews and other sources.

The investigation found that the intense pressure on North American Dental’s offices to meet daily revenue targets led to allegations of overtreatment. Patients complained they were diagnosed with a mouthful of cavities only to later discover nothing was wrong with their teeth. Employees said they felt uncomfortable with what they witnessed.


“I have watched them drilling perfectly healthy teeth multiple times a day every day,” dental assistant Ashley Hughes said in an interview. She worked for two years at a North American Dental office in Austintown, Ohio, not far from where Gregory was treated.

The financial squeeze was part of a daily companywide ritual known as the “morning huddle.” Staff said they met before the doors opened to discuss how to fill gaps between that day's targets and scheduled treatments.

North American Dental pits office against office and dentist against dentist by sending out monthly tables ranking dentists and hygienists by who’s making the most money per appointment. Offices failing to hit their goals are colored in red – and told to step it up.

“Congrats to teams Alpine, Deerfoot and Life Smiles for starting the month out on a high note, exceeding their budget,” one regional manager wrote in a July email to 11 Indiana offices. “Everyone else has a deficit to overcome.”

Nicky Demecs' Facebook review of Corner DentalCOURTESY OF NICKY DEMECS

USA TODAY and Newsy interviewed 20 patients who sought second opinions after being told at a North American Dental office that they needed extensive dental work. In each case they said the second dentist prescribed little to no dental work.

A dentist at Refresh Dental in Kent, Ohio, told first grade teacher Jennica Watson that she had seven cavities. Watson says she brushes twice a day and has checkups every six months. She went to another dentist, who said she had no cavities at all.

Twenty‑seven‑year‑old Alex Miller, who installs countertops, switched to a new dentist at Corner Dental in Maumee, Ohio, who told him that he had nine cavities. Suspicious, Miller went back to his family dentist, who told him he had none.

Gregory, at 3, when his root canals became infected.COURTESY OF JOHANNAH LANCASTER

Nicky Demecs went to Corner Dental in Oregon, Ohio, and was told she had five cavities on one side of her mouth and three on the other. She had half the work done, then decided to get a second opinion: no cavities.

Patients had no way of knowing that their dental office was managed by a company beholden to Wall Street investors or that their dentists and hygienists were expected to meet revenue goals. As North American Dental snapped up offices, it often retained their original names.

Private dental chains receive virtually no oversight. These companies don’t have to file financial statements with the Securities and Exchange Commission. And state dental boards tend to only regulate dentists, not the companies. Even then, USA TODAY/Newsy found that dental boards rarely act on complaints.

In 3-year-old Gregory’s case, the Ohio state board did review the case. It suspended Griesmer's license more than a year later, board records show, only after Griesmer continued to treat other children without providing X-rays or adequate records to the board while under its supervision.

Gregory continued to have problems after the root canals, according to his mother and records from a malpractice lawsuit. While he was recovering from general anesthesia, one of his seven crowns fell off. Lancaster said she told the assistant, who came back with a message from Griesmer: He had used off-the-shelf crowns that “were the smallest ones made and they were still too big for Gregory and that it’s fine.”

But it wasn’t fine. More crowns came off over time and eventually Gregory’s right cheek swelled so much it looked like it might pop. Lancaster rushed him to an emergency room, where they drained pus. Later, a dental clinic pulled four of the teeth Griesmer had treated.

Gregory faced more surgeries to fix the damage, according to the family’s malpractice lawsuit. Those medical bills came to $23,000.

Last week, Griesmer told USA TODAY that he figured out that Gregory needed root canals – called pulpotomies when done on baby teeth – “just by sight.” He said he never took X-rays on 3-year-olds because they won’t sit still for them.


Johannah Lancaster I figured he is a professional so I trusted him.


“I’ve been doing it for 30 years,” he said. “I pretty much know what needs to be done.”

Griesmer acknowledged the company pushed dentists to make money but said that never influenced his treatment choices. He acknowledged the crowns he put in were too big and expressed regret about Gregory’s complications.

“In hindsight I would have taken some of those teeth out,” he said. “I wish I had it to do all over again.”

In March 2015, the dental board suspended Griesmer’s license for a year. The lawsuit was settled out of court for $20,000. Griesmer retired from dentistry and left North American Dental.

Gregory still fears dentists and his mother feels bad about the pain he suffered.

“The way that Gregory cried,” Lancaster recalled, pausing. “It’s sad.”

Company denies debt drives treatment decisions

North American Dental would not comment on Gregory’s case, or that of any other patients named in this story, beyond pointing out that some of the dentists involved are no longer with the company.

Generally, the company denies allegations of overtreatment, saying that its mission is “to deliver best-in-class patient care” and give its dentists complete autonomy in making diagnoses. An affiliated company owned by its dentists reviews dental work for any quality issues, the company said.

These so-called dental service organizations were virtually nonexistent 20 years ago, but by 2017, 17,600 dentists nationwide worked at them, according to the American Dental Association. Investment firm William Blair & Company estimated in 2017 that dental chains made up 16% of the market and pegged their growth at 15% a year.
https://www.gannett-cdn.com/indepth-static-assets/uploads/master/4536783002/f3922b7d-a0a5-41d5-8cec-065221c7d9f5-desktop-animation-new.mp4

Open Wide: Dentists under pressure to drill ‘healthy teeth’ for profit
A fast-growing dental chain pressures dentists to hit revenue targets daily, leading to claims of root canals and treatments patients don’t need.
NEWSY / USA TODAY, USA TODAY

Another kind of debt is helping fuel the growth of private-equity-owned dental offices: student debt. According to the American Dental Association, the average dental student graduates owing $287,000. Young dentists who can’t afford their own practices leave retiring dentists with fewer prospective buyers. That creates a buyer’s market for private-equity investors.

Some of the issues North American Dental faces are common among companies weighed down by debt from leveraged buyouts, said Eileen Appelbaum, an expert on private equity and economist at the Center for Economic Policy Research.

“The big private equity firms have gotten very active in the medical field, which is a little bit concerning,” she said. “We're not really sure that Wall Street is the best place to make medical decisions for us.” 

Tips for vetting your dentist
Check social media reviews: Yelp, Google, Facebook.
Ask your dental office who runs it; check its website for ownership.
Ask the dentist if X-rays or optional treatments are really needed.
Get a second opinion if your dentist recommends a lot of treatment.
Check whether they are a member of the American Dental Association.
Search the dentist’s license for disciplinary actions by your state dental board.

Like many other dental chains, North American Dental Group teamed up with private-equity investors early on. Because these investors typically buy businesses by putting little money down and borrowing the rest, dental chains are forced to pay the debt.

North American Dental, however, denies debt is a problem.

“We understand that it’s an easy – and perhaps attractive – hypothesis to imagine that dentists are motivated or pressured to drive up revenue to satisfy debt loads by talking patients into unnecessary care or cutting corners,” the company said in a statement. But the company is “set up, top to bottom, to prevent that from happening.”

Kenneth Cooper, left, CEO of North American Dental Group, and Andrew Matta, a dentist who co-founded the company.JEFF SWENSEN, FOR USA TODAY

The company also downplayed the role of revenue goals. In an interview, North American Dental’s co-founder and chief executive officer Ken Cooper described revenue targets as just “meeting the budget.”

The Department of Justice won multimillion-dollar settlements against two other dental chains, alleging they had defrauded Medicaid by performing unnecessary root canals on children. One went out of business.

Cooper said his company has learned from problems with other corporate dental chains.

“Some of our peers have had missteps a couple of times,” he said. “We’ve learned from that.”

North American Dental said ultimately, the responsibility for treatment rests with the dentist, not the company. It noted that conflicting opinions are common in dentistry, citing a 1997 Reader's Digest story for which a reporter visited 50 dentists and received a wide range of diagnoses.

When asked if the company was concerned about Yelp and Google reviews where patients complain about overtreatment, Cooper said an internal analysis indicates patients are happy.

“You can go to any company in America and find a social media negative review, literally every company,” he said. “Even Disney World.”

Employees say they saw dentists drill healthy teeth

Former employees of North American Dental contend that pressure to overtreat stems directly from the company’s revenue goals. Ashley Hughes, the Ohio dental assistant, still cannot believe what she witnessed.

Shortly before 8 a.m. daily, staff would gather in the break room for a morning huddle at which the office manager laid out the revenue gap between the office’s target and scheduled treatments. They nearly always began the morning thousands of dollars short, Hughes recalled. Small bonuses were dangled for exceeding targets.

“Before we saw our first patient of the day, they would discuss money and figures and what we needed to do to get to where they wanted us,” she said.

Besides drilling healthy teeth, Hughes said she saw dentists perform root canals on teeth that instead needed to be pulled. Root canals are much more lucrative. According to insurance company Delta Dental, pulling a tooth in Austintown costs up to $183 while a root canal can cost $1,142.

Refresh Dental in Austintown, Ohio, where dental assistants say they regularly saw dentists drilling into healthy teeth.JEFF SWENSEN, FOR USA TODAY


A deeply decayed tooth inevitably will have to be pulled later, exposing the patient to the possibility of serious infections, according to Dello Russo, the Boston dentist who reviewed case files for USA TODAY/Newsy. He characterized root canals on badly decayed teeth as a way to double-dip, allowing dentists to charge first for the root canal and later to pull the tooth.

Hughes said she noticed that kind of double-dipping a lot.

“The patient is coming back a month later because their faces are blown out because they were infected and the teeth needed to be extracted,” Hughes said. “but we needed that money.”

Dental assistant Ricci Endsley worked alongside Hughes at Refresh Dental in Austintown, a hectic office along a commercial strip with one full-time and one part-time dentist. She said she routinely saw patients being diagnosed with problems they didn’t have or being billed for treatments they didn’t get.

For example, she said one patient was charged for a tooth being surgically removed when the patient actually had had a simple extraction. One costs $305, the other $183. She saw root canals crowned with decay left inside, meaning the patient would be back later to have that same tooth pulled.


Ricci Endsley
I told the office manager, ‘I will not go back in there. I will not be any part of what's going on in that room.'


“There wasn't one day that I worked there that I could say that that was a good day,” Endsley said. “Every day there was an issue with either something being billed that wasn't done or it wasn't billed properly or the standard of care was not there.”

At times, she said, she would peel her gloves off in the middle of a procedure and walk out.

“I told the office manager, ‘I will not go back in there. I will not be any part of what's going on in that room,’” Endsley said.

Sometimes she would go home at night in tears.

Hughes and Endsley said they frequently took their complaints to the office manager, who would pass them to her regional director, but nothing ever happened.


Dental boards rarely take action
Read

“If I saw something or assistants questioned, ‘I don’t think this person needed a root canal, etc.,’ the only recourse I had was to take X-rays and send it up the chain,” said former office manager Dixie Weisgarber. “That would happen quite often.”

The assistants finally went to the Ohio dental board to report inadequate care, unhygienic practices and overbilling of patients. The board conducted a brief investigation but – according to board records – dismissed the complaint without taking any formal action.

This is not unusual. The Ohio board has four investigators handling nearly 500 investigations a year. Only a dozen or so of those result in suspension of a dentist’s license.

Frustrated, Hughes and Endsley both quit in 2016. They continue to work as dental assistants and say they’ve never seen anything like it at other dental offices.



Asked specifically about the morning huddle, Cooper had a different take.

“It's a big part of our culture,” he said. “They open up each morning with personal professional gratitude and really just a way to help lift the spirits in the office like, ‘Hey, what do we really care about? We're here to serve patients.’”

Endsley shook her head.

“I don't know what kind of morning huddle he's ever sat in on,” she said, “but for 14 months, everyone I've sat in on was not at all encouraging.”

A patient dies in the parking lot

Unnecessary fillings and crowns can lead to a lifetime of expensive dental work as they wear out and need to be replaced. But in rare circumstances a trip to the dental office can also be deadly.

April Walters was in fragile health when she went to a Detroit-area dentist to have 19 teeth pulled. In fact, the first time she went in March 2016, the dentist at Dental Care of Michigan postponed the procedure after checking her heart rate.

The dentist, Rana Rabban, had been out of dental school less than two years.

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But the second time Walters went, Rabban pushed forward. Walters’s doctors had approved her for the treatment despite her high blood pressure.

She wore an oxygen tank during the procedure because of serious lung diseases. Her blood pressure was high and her heart, the records show, was racing at 135 beats per minute.

Surgery under those conditions calls for an experienced anesthesiologist, who could monitor the patient carefully, said Heddy Dale-Matthias, an anesthesiologist who reviewed Walters’ records for USA TODAY/Newsy. That would have meant sending April to an oral surgeon, she said.

Details of what happened are contained in dental records and alleged in a malpractice lawsuit the family brought against the dentist and the office last year. Walters’ sister, Crystal Cutright, testified that she sat in the dental chair with Walters, stroking her hair during the treatment.

Concerned, Rabban stopped the procedure early. Walters collapsed in the parking lot. CPR didn’t save her. The family’s malpractice lawsuit is still pending. In response to it, both Rabban and the company denied they did anything wrong.

Non-dentists question dentists' treatment decisions

While North American Dental says dentists are in total control of patient care, interviews with former employees and emails suggest a different reality.

The manager overseeing a cluster of offices in the region that includes Austintown emailed daily, Hughes said, going over patient records and billings and “wanting to know why we didn’t do certain procedures on patients.” That manager was not a dentist.

It didn't just happen in Ohio. In a July email to 11 Indiana dental offices, another regional manager, Sarah Watson, notes that only three were meeting their monthly revenue targets. Watson was a former regional manager for LensCrafters and Pier 1 imports, according to her LinkedIn profile.

Watson’s email, obtained by USA TODAY/Newsy, asks dentists not meeting their goals if they are following procedures to entice more patients to agree to fluoride treatments, bone grafts and oral cancer screenings. Dello Russo said those procedures tend not to be covered by insurance and can be used to drive up billings.

Calls for appointments with local dental offices route through to North American Dental Group headquarters in New Castle, Pennsylvania.JEFF SWENSEN, FOR USA TODAY


Watson also asks dentists whether they are getting patients to agree to treatments before telling them how much they will have to pay out of pocket.

Neither Watson nor the company responded to questions about the email.

Cooper, the company’s chief executive officer said the problem in the industry now is that insurance won’t cover some treatments, so dentists often let patients walk out the door with disease in their mouths.

“Doctors have been trained to treat to insurance; so there is undertreatment out there, not overtreatment,” Cooper said.

To prevent this, North American Dental tracks how often dentists diagnose advanced gum disease. If an office is diagnosing the disease less often than disease prevalence statistics from American Dental Association, Cooper says the dentist will be told about it and may get training about the disease.

Yet an executive for the American Dental Association cautioned that its disease statistics shouldn’t be used to guide diagnoses.


Dental assistant Ashley Hughes
I have watched them drilling perfectly healthy teeth multiple times a day every day.


“There is never a time where a population statistic will override the individual needs of a patient,” said David Preble, senior vice president of the ADA’s Practice Institute.

The treatment for advanced gum disease is typically expensive deep cleanings. Several former employees said patients without the disease frequently were sold deep cleanings.

Cheryl Knab, a benefits administrator, says this is what happened to her a little over two years ago at a North American Dental office in Westlake, Ohio. In Westlake, the cost of a regular cleaning is $91 to $104, according to Delta Dental, while a deep cleaning costs more than $1,200 for a full mouth.

Knab returned to her previous dentist, who told her she did not need a deep cleaning. When Dello Russo, a periodontist who specializes in gum disease, reviewed her X-rays, he agreed.

Dental chains skirt laws requiring dentist owners

In most states, you have to be a dentist to own a dental practice. The impetus for those laws is the common belief that dentists will look after the patient’s best interest.

Dental chains, including North American Dental, have devised company structures that allow them to skirt those laws. North American Dental rents the office, owns the equipment, employs the staff, handles the billing and, according to insiders, sets the revenue targets. The dentists are employed by a second affiliated company that owns the practices.

North American Dental Group was started by someone who never went to dental school. After less than a year at Ohio’s Youngstown State University, Cooper became the lead singer in a guitar-driven rock band that released a single album with Atlantic Records.

How private equity firms got involved in dentistry
In recent years, private equity has helped fuel a trend in healthcare consolidation.
NEWSY / USA TODAY, USA TODAY

During that time, he faced lawsuits and tax liens for unpaid debt. He also in 2002 pleaded no contest to a felony drug charge and was sentenced to 180 days in jail suspended and 12 months of probation. (Recently he went back to court and had his criminal record expunged.)

A few years later, he landed a job in a dental office in Canfield, Ohio.

“I was actually wearing scrubs, working the front desk, checking in patients,” Cooper recalls. “I didn't have a background in dentistry.”

But he came up with the idea of putting together a group of dental offices. He opened his first Dental Express office in Canfield, Ohio, in October 2008. Soon, however, Cooper faced problems.


TWEETSHAREKenneth Cooper, CEO of North American Dental Group
I was actually wearing scrubs, working the front desk, checking in patients. I didn't have a background in dentistry.


One dentist, who sold his practice, accused Cooper of withholding $300,000 for treatments the dentist had performed. He sued Cooper and the case settled out of court. Two of Cooper’s early dentists, including Griesmer, had their licenses suspended. One dentist convicted of writing narcotic prescriptions for nonpatients got his license back later.

Despite those bumps, Cooper’s dental group drew the interest of a Boston private equity firm, Abry Partners. In 2012, Abry invested in Cooper’s company in a deal worth an estimated $40 million, according to Pitchbook, a private-equity research firm. That allowed the company to buy more offices.

The debt from private-equity-driven leveraged buyouts can put tremendous financial pressure on companies like North American Dental. In December 2017, North American Dental Group had total debt of $128 million, according to company financial data reviewed by USA Today/Newsy.

Daniel Krueger, a dentist who owned shares in North American Dental Group, said the company made it clear 2017 was a "do or die" year.CARRIE COCHRAN, NEWSY

Daniel Krueger, a dentist and until recently one of a small number of individual shareholders of North American Dental, said he was told in 2017 by someone at the company – he believes it was Cooper – that the company critically needed to refinance its debt. Krueger said the urgent message was that he had to sign papers agreeing to the refinancing.

“This was a do or die moment for the company,” he said. ‘We've got to get this financing.’"

The company declined to answer most questions about its financial condition, saying that it pays its debts. But the company data reviewed by USA TODAY/Newsy shows that debt nearly doubled in 2018 to $229 million at the end of the year, North American Dental lost $25 million in net income in 2018.


Late last year, North American Dental’s private-equity owners sold the company to Jacobs Holding, a Zurich-based firm that invests on behalf of a nonprofit foundation. So far, Jacobs has not replaced top management or made noticeable changes to practices uncovered by the USA TODAY/Newsy investigation.

Jacobs did not respond to email requests for an interview.

At the time of the purchase, the CEO of Jacobs Holding said in a news release: “With its high-quality standards in dental and patient care, North American Dental is a perfect fit with our vision and values.”

Social media reviews expose high-production offices

As it grew, North American Dental bought high-revenue-generating dental offices, some of them already being criticized on social media for overtreating patients.

In 2015, the company bought 11 Indiana offices from Krueger that had been targeted on social media. Among the critics was a Purdue University graduate student, Nick LaBonte, who was told by Krueger that he had 16 cavities. When LaBonte sought a second opinion, another dentist said he had no cavities at all.

Verena McClain, a student from Germany, joined the fray after she was treated by Krueger two years after he joined North American Dental.

Verena McClain's Yelp reviewCOURTESY VERENA MCCLAIN

Krueger told her she needed to replace a crown she had just gotten in Germany. Over the course of two more visits, he said she needed four crowns, at a cost of $5,900. With insurance and a discount, her out-of-pocket share would come to $3,300.

She decided finally to ask another dentist, who said nothing was wrong. McClain asked her to double-check.

“She looked at them again more closely and said, ‘No, there's nothing wrong with your teeth,’” McClain said.

Dello Russo reviewed X-rays for both McClain and LaBonte, and confirmed neither needed the work done.

“It's one thing if you go to your car mechanic and they recommend something that you don't really need,” McClain said. “But losing your perfectly healthy teeth, that's a part of your body that they're violating. How dare you try to do that to me?”

Verena McClain's X-rays were taken at Daniel Krueger's office in West Lafayette, Indiana in 2016.CARRIE COCHRAN, NEWSY


Echoing the company’s perspective about second opinions, Krueger told USA TODAY/Newsy that different dentists can see things differently. Some offer a lot of options and some will leave decay in a patient’s mouth and wait to see if it gets worse.

“I don’t remember that exact particular situation, but I’m glad that she went and found some other dentist that she felt comfortable with,” he said. “But my recommendations – 100% – I stand by them. What I recommended for the patient, I would do it for my family member.”

And, Krueger added, the onus is on the patient to be a savvy consumer.

Complete Dental Care, seven offices in eastern Ohio and two in Pennsylvania, that dentist Robert Doyle sold to North American in 2018, also has been accused of unnecessary treatments on social media. A whistleblower lawsuit in federal court adds heft to those accusations, saying that those practices and North American Dental are defrauding Medicaid by diagnosing unnecessary root canals.


The whistleblower, John Kramer, runs the only competing dental office in Martins Ferry, Ohio. When he started seeing patients seeking second opinions, he was shocked.

The lawsuit says Kramer saw one patient last May who had just gotten two root canals and was told she needed more, but X-rays showed otherwise. Shortly after, Kramer saw another patient who was told he needed 18 root canals.

Kramer alleges that while nine teeth needed to be pulled, the other teeth were fine. Kramer said in the lawsuit that not only did the patient not need root canals, but no patient would ever need 18 of them at once.

Verena McClain was told she needed four crowns at a North American Dental by Daniel Krueger but a second dentist told her she needed none.JARRAD HENDERSON, USA TODAY

Lawyers for North American Dental and Doyle dismiss the federal lawsuit as a dispute between competing dentists and say Kramer has failed to prove his allegations.

In an interview, Doyle’s lawyer, Elizabeth Stepp, denied all allegations of fraud. She said It makes no sense that any dentist would risk losing their license to hit revenue targets or that any dentist could be told to perform procedures that they didn’t believe were medically necessary.

She said of revenue targets, “It’s more about how hard are you working not how many unnecessary procedures are you doing,"

If Kramer prevails, he stands to get 30% of the judgment with the rest going to Medicaid for fraudulent payments. But he insists money is not his motivation. Instead, he said, he believed a lawsuit “was the quickest way to stop (the) behavior.”

His lawsuit alleges that unnecessary treatments are systematic at North American Dental.

It cites an unnamed company insider who says that starting in March 2019, North American Dental created a team including Doyle to teach offices in Cleveland and Pittsburgh how to increase their revenues.

Since then, the lawsuit alleges, the office in Shaker Heights – a Cleveland suburb – has grown daily revenues from $5,000 to as much as $12,000. The goal is $15,000.

The secret to success? The company insider alleges that Doyle’s team taught hygienists to add root canals to patients’ treatment plans, even if the dentist said no root canal was medically necessary.

Carrie Cochran and Lauren Knapp at Newsy and Ciara Bri'd Frisbie contributed to this story.

David Heath is a reporter on the USA TODAY national investigations team. Contact him at dheath@usatoday.com or @davidhth, or on Signal at (240) 630-1962. Mark Greenblatt is a senior investigative reporter with Newsy. Contact him at Mark.Greenblatt@scripps.com or @greenblattmark.Originally Published 5:06 a.m. MDT Mar. 19, 2020
Updated 10:11 a.m. MDT Mar. 19, 2020





Dental boards rarely punish dentists for unnecessary treatment
State dental boards investigate lots of complaints about bad dentistry, but In a typical year, they suspend only 0.1% of dentists’ licenses.David Heath, USA TODAYUpdated 7:23 a.m. MDT Mar. 19, 2020

If you suspect your dentist may be recommending treatments you don’t actually need, you can complain to your state dental board. Odds are, nothing will happen.

As is true for other medical professions, state dental boards are typically made up of dentists overseeing dentists, leaving the profession to police itself.

Nationwide, dentists rarely have their licenses pulled by their dental boards. In 2018, according to data from the federal Department of Health and Human Services, state boards revoked or suspended only 225 licenses – 0.1% of all dentists. Ten states didn’t suspend a single dentist.

The Ohio dental board, featured prominently in a USA TODAY/Newsy investigationLINK, is a case in point and suspensions for overtreatment are rare there. It averages about 450 complaints a year, yet last year, board records show that it suspended only nine licenses and revoked three others.



Michael Davis, a New Mexico dentist who advocates against corporate dentistry, says the vast majority of dental boards are lax on enforcement.

“They are unmotivated,” he said. “They are underfunded. The quality of the personnel on the dental board is poor.”

INVESTIGATION: Dentists under pressure to drill ‘healthy teeth’ for profit

USA TODAY and Newsy reported allegations that a push for profits is leading to overtreatment at one of the nation’s largest dental chains, North American Dental Group.

North American Dental Group headquarters in New Castle, Pennsylvania. The company has been among the fastest-growing dental chains in America.JEFF SWENSEN, FOR USA TODAY

Two former dental assistants at Refresh Dental in Austintown, Ohio, part of the North American Dental chain, brought similar complaints to the Ohio dental board. Ricci Endsley and Ashley Hughes saw it as their only recourse, they said, because nothing seemed to change after their complaints about patients being mistreated were sent up the company’s chain of command.

"I started gathering evidence,” recalls Ricci Endsley, who worked in the Austintown office from 2015 to 2016.

Similar claims have been made against other corporate chains – some resulting in other kinds of crackdowns.

The owners of both Kool Smiles and Small Smiles settled whistleblower lawsuits spearheaded by the Justice Department alleging that they were defrauding Medicaid by performing unnecessary root canals on children. Each reimbursed the government about $24 million. Small Smiles eventually went out of business.

Endsley claims that she saw cases in Austintown where patients were given treatment, like a root canal, that they didn’t need. Or they were billed for a treatment they didn’t receive. Or the dentist left decay inside a tooth and told an assistant to go ahead and put a crown on it, inevitably leading to complications. She started secretly writing information on Post-it Notes.



Ricci Endsley I started gathering evidence.


“I would keep everything in my pocket,” she recalls. “I would take them all home and I would keep them in a little pile… I would sit down and write a list of each patient, what I knew, what I saw, what I believed was wrong. I then called the state dental board and asked them how I could file a complaint.

Endsley talked to the dental board’s chief investigator, Damon Green, in July 2016 and forwarded him her information. Within a few days, emails show, the board notified the dental office that it was under investigation. For weeks, Endsley kept sending emails with new details.

On Nov. 10, 2016, she was sent a letter from board member Ashok Dak, a dentist, saying that “after careful deliberation of all the evidence available to the Board, please be advised that appropriate action has been taken to ensure that the licensee maintains the standard of care for the profession.”

Board minutes show the investigation had been dismissed with no formal action a day earlier.

The board has a confidential remediation program known as the Quality Intervention Program, too. However, board minutes show it’s rarely used and that no one was in the program during the November board meeting or during subsequent meetings in December and February.

Endsley was unaware that the board had dismissed her complaint with no formal action until USA TODAY/Newsy investigated.

Dental assistant Ashley Hughes, right, complained to the Ohio dental board with co-worker Ricci Endsley.JEFF SWENSEN, FOR USA TODAY

“I feel like the board failed at their job,” Endsley said. “They failed patients and employees.”

It can be hard to evaluate a board’s effectiveness because, by law, information about investigations only becomes public if formal action is taken. In fact, a spokesman for the Ohio dental board cited confidentiality of investigative records in declining to comment for this story.

The board, comprised of 10 dentists and 2 hygienists, oversees 36,000 licensed professionals, including 7,500 dentists. It dismissed 374 complaints last year with no action and left others unresolved.

SEE ORIGINAL ARTICLE FOR INFOGRAPHICS AND EMBEDDED PDF'S
https://www.usatoday.com/in-depth/news/investigations/2020/03/19/dental-chain-private-equity-drills-healthy-teeth-profit/4536783002/

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Scientists chase two fronts in how to treat coronavirus but 'there's no magic drug right now'

Elizabeth Weise USA TODAY 3/24/2020


SAN FRANCISCO — Doctors and scientists are working furiously to find effective treatments for the illness caused by the new coronavirus but are cautioning the public not to self-medicate or hoard mentioned drugs not yet proven to work.

Despite widespread rumors, social media reports and President Trump's own optimism surrounding the effectiveness of several existing drugs, so far there are no proven treatments for COVID-19, according to the U.S. Centers for Disease Control and Prevention.

“There’s no magic drug out there right now,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said at a news conference on Thursday.

When COVID-19 treatments do arrive, they will likely fall into two categories, say experts. The first will be aimed at slowing down replication of the virus in patients early in the disease. The second will help stop the deadly autoinflammatory response in the lungs in its critical stage.

The drugs touted by the president include the malaria drugs chloroquine and hydroxychloroquine, the experimental antiviral drug remdesivir and azithromycin, a bacterial antibiotic. They remain, however, classed as “investigational therapeutics” because there isn’t enough data to show they are a safe and effective treatment for the illness.

“We often see antiviral therapies (that are promising) in the test tube and animal models. But before we give it to patients with confidence, we really need to see the data in humans,” said Jeffrey Klausner, a professor medicine and public health at the University of California, Los Angeles.

Anecdotal evidence may show when people are given a certain drug their condition improves or stabilizes but other factors could be at play. A person may have gotten better on their own, made it to the hospital more quickly or had fewer underlying risk factors impacting the course of the illness.

“Many drugs have been thrown out as being possibly helpful. But right now, we don’t have a good control of who’s getting it and at what stage," said said Rodney Ho, a professor of pharmaceutics at the University of Washington in Seattle who researches viral diseases and treatments. "We don’t have a complete picture yet.”

Labs and companies worldwide are busy screening likely drug candidates to see if they bind to proteins on the surface of the SARS-CoV-2 virus that causes COVID-19. The problem is, a screen only tells you whether the proteins bind, not the effects, explained Kevan Shokat, a professor of cellular and molecular pharmacy at the University of California, San Francisco.

Proteins can block or activate responses in a cell, so a drug could stop a function the cell uses to protects itself making the patient worse. It could “actually help the virus,” he said.

“There could be drugs that have no benefit, drugs that have a benefit and drugs that do harm,” Shokat said.

No one should expect immediate clarity, said Marc Jenkins, who directs the center for immunology at the University of Minnesota Medical School in Minneapolis.

“Every possible strategy will be tried," he said. "I suspect that’s going to be confusing for a while because there will be so many things being tried."

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Patients with COVID-19 go through a series of stages in their illness. Exact percentages are impossible to know yet but general patterns are beginning to emerge.

For some of those infected, there are few to no symptoms. By far the largest group currently visible to medical professionals are those who present with fever, headaches and cough, and in some cases shortness of breath. Most will get better on their own.

Currently, it appears about 15% of those infected go on to have severe illness and need to be hospitalized. Another 5% become so ill that they must be treated in an intensive care unit.

Antiviral drugs would be used early on in the infection to slow or stop the virus from reproducing in the patient’s body, allowing the immune system to respond, shortening illness duration and halting progression to more severe forms of the disease.

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Such treatments would be similar to antiviral medications given at the onset of the seasonal flu, such as Tamiflu. Available only by prescription, these drugs, taken within two days of becoming sick, can lessen fever and flu symptoms and shorten the length of illness by about a day.

While numerous possible antivirals that might work against the virus have been in the news, none have been tested to ensure they work against the disease or are safe.

These include remdesivir, chloroquine and hydroxychloroquine, a combination of two HIV drugs, lopinavir and ritonavir and a triple combination of lopinavir and ritonavir plus interferon-beta. Favilavir is being tested in China.

Antivirals are often given in combinations to help decrease the chance the virus can survive and mutate into an untreatable form but they take longer to test.

“Combinations take a long time, you have check (the safety of) each drug at different doses in combination with other drugs in different doses,” said Shokat.

Drugs to halt the cascade of illness

COVID-19 patients with severe illness can develop acute respiratory distress syndrome, or ARDS. This extremely serious syndrome isn’t caused by the virus but by the body’s response to it.

The inflammatory response can include the release of chemicals that can trigger fever and low blood pressure. It can also cause small blood vessels in the lung to leak fluid and fill up the alveoli, the tiny air sacs in the lung that process oxygen and bring it into the bloodstream.

“The vast majority of patients who die from COVID-19 are dying from ARDS,” said Michael Matthay, a professor of medicine and expert on the syndrome.

As the COVID-19 pandemic grows researchers are focusing drugs including monoclonal antibodies that bind to molecules that cause or worsen the cascade of symptoms.

Some of the drugs being investigated include Actemra (tocilizumab) and Kevzara (sarilumab) – both used to treat rheumatoid arthritis – and the experimental drug gimsilumab.Others are being investigated.

In the meantime, experts urge people to remain calm and not experiment themselves with unproven drugs that could have side effects worse than the disease itself.

“Every drug has toxicity, it could make you worse or it could make you better," said Shokat. "That’s why drugs take a long time to develop – because we have to make sure."

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USA TODAY 3/24/2020

THANK CANADA AND AUSTRALIA
Olympics officially postponed due to coronavirus outbreak

Tom Schad USA TODAY 3/24/2020

For thousands of athletes around the world, it would have once been considered a nightmare scenario.

And on Tuesday, it finally became official.

In an unprecedented and unavoidable move, Japanese Prime Minister Shinzo Abe told reporters in Tokyo that he and International Olympic Committee president Thomas Bach have agreed to postpone the 2020 Summer Olympics.

According to a tweet from the Japanese Prime Minister's Office, the two agreed that the Games will not be canceled and "will be held by the summer of 2021."

It is the first time in modern Olympic history that a global health issue has disrupted the Games.

The announcement followed telephone conversations between Abe, Bach and their respective teams Tuesday. It comes less than 24 hours after long-standing IOC member Dick Pound first told USA TODAY Sports that the Games would not begin as scheduled on July 24.

While the Olympic Games have previously been canceled during periods of war, and complicated by boycotts, this is the first time they have ever been suspended.

The decision to move the multi-billion dollar event will have widespread political, legal, logistical and financial ramifications, both locally in Japan and around the world.

It also figures to cause headaches and heartaches across the international sports community — for federations and leagues that must now adapt their schedules, and for the 11,000 athletes who had spent years training to compete this summer.

Despite its complexities, this path became increasingly inevitable in recent weeks, as the novel coronavirus, also known as COVID-19, continued to spread. The disease, which was first identified in Wuhan, China in December, has now infected people in more than 160 countries around the world, shuttering entire cities and leaving thousands dead.

In the process, it also wreaked havoc on the Olympic qualifying model, forcing several international sports federations and national Olympic committees to postpone or cancel key events. Some athletes and coaches were stranded in foreign countries due to travel restrictions. Training regimens were disrupted. The Greek leg of the Olympic torch relay was held without fans, then canceled.

Yet despite those disruptions, and the rapid spread of the coronavirus, IOC officials and representatives from the Tokyo 2020 organizing committee maintained for months that the Olympics would not be affected. IOC president Thomas Bach urged athletes to continue training as usual, even as questions about the Games continued to swirl.

That determined approach changed as the opening ceremony drew closer and global health concerns about holding the event lingered.

Athletes helped fuel the process by speaking out publicly, or pressuring their sport's governing body or national Olympic committee to take a stand. In the United States, for example, leaders from swimming, track and field and gymnastics all urged the U.S. Olympic and Paralympic Committee to publicly call for postponement, which it later did.

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The move to postpone the Games figures to have dramatic financial implications for several stakeholders, including the IOC – whose budget relies in large part on income from broadcast partners related to the Olympics – and Japan, which has already spent more than $28 billion to host these Games, according to the Associated Press.

One Japanese securities firm estimated earlier this month that a cancellation or postponement of the Olympics would reduce the country’s annual growth domestic product growth by 1.4% in 2020.

The IOC has paid insurance premiums north of $12 million in both 2016 and 2018 to protect against the possible disruption of the Olympics, but Bach did not provide a figure for this year’s premium when asked by reporters earlier this month. The IOC had nearly $2 billion in reserve as of its most recent annual report, which was released last summer.

Japanese citizens have embraced their role as hosts of the Games, buying up tickets as soon as they became available. Organizers expected to sell about 7.8 million tickets, with at least 70% of them going to Japanese residents.

Beyond finances, this decision will also cause substantial disruptions for athletes, many of whom have put off college or other opportunities to train full-time with the objective of peaking in July. Now, they will have to put their training on hold. Some might be forced to give them up altogether — their Olympic dreams dashed, a nightmare come true.

Contributing: Nancy Armour, Rachel Axon, Christine Brennan and The Associated Press

Contact Tom Schad at tschad@usatoday.com or on Twitter @Tom_Schad.