“The last year and a half has taken a toll on us,” said Jodie Connelly, nurse manager of the intensive care unit at the hospital, which is part of the Intermountain Healthcare System based in Salt Lake City. “Nurses have pretty thick skins, but the pandemic has tested us in ways we’ve never really been tested before.”

The community the hospital serves noticed that strain and came up with a novel idea to help the hospital’s workers. Park City’s residents raised enough money — through contributions from more than a dozen residents and two large seed donors — to fund a pop-up grocery store out of a room in the hospital that had been a private dining area.

The hospital uses about $10,000 of the donations each month to stock the store, and all goods are free to any hospital employee.

At first, the store offered ready-made pasta, chicken and mashed potatoes, and other meals, including vegetarian options, that caregivers could take home or eat during their shift. Later, grocery basics such as milk and eggs were added for employees to stock their fridge. Today, the Park City Hospital store has expanded to include nonperishable items such as cereal, sugar, oatmeal and pasta, plus a variety of fresh produce options.

Connelly said she especially appreciates convenient access to fresh fruits and vegetables. “While I keep my pantry at home full of nonperishables, I would have to stop at the grocery store more often if I wasn’t able to take fresh produce home with me,” she said.

Selene Macotela-Garcia, a food service supervisor at the hospital who stocks the store, said she tries to find a variety of items to offer. “Everyone gets excited when we bring in new items,” she said. She recently added lemons, eggplant, beets and cabbage to the mix. “Having sweet potatoes before Thanksgiving was especially popular,” she said.

Macotela-Garcia explained that some employees pick up enough ready-made food to bring home a precooked meal for each family member instead of having to prepare something once they arrive.

The store allows the hospital’s staff to avoid public places where the risk of covid transmission is high, such as grocery stores, and helps them save money. “Finances have been tight; some of us need help more than people may realize,” said Gregoria Taboada, a food service worker at the hospital who frequents the store.

But the store has been useful in helping the hospital’s caregivers save on a commodity in especially short supply these days: time.

“It means so much to me that after a 13-hour shift I don’t have to stop at a grocery store to pick up the basics,” Connelly said.

Work-life balance is hard to maintain as the toll from pandemic care has driven some employees to quit and those remaining are often asked to pick up the slack.

“I started taking on extra shifts each week to help out,” said Katie Peabody, a nurse in the hospital’s intensive care unit. “I frequently work 50-plus hours a week doing work that has become so physically, emotionally and mentally taxing,” she said.

Grueling labor conditions are among many factors noted in a showing why nurses have suicidal thoughts more frequently than people in other professions.

“Sometimes there are only two nurses in the ICU with no techs or secretaries to field phone calls or help out,” Peabody said.

While Utah is among of fully vaccinated states, Park City’s Summit County is the most vaccinated in the state with 80% of its residents fully vaccinated. Because of the city’s high number of tourists, however, the county’s current transmission level is still in the highest category.

The store is also a boost to morale, workers said, especially as they cope with another change of late: patients who no longer trust or appreciate them. “None of us are looking to be a hero,” Connelly said, “but we used to have a great relationship with our patients and their families. That has changed in many cases during the pandemic.”

She noted that almost all the covid patients she’s treated this year are unvaccinated and most have very strong feelings about preventive measures such as the use of masks and vaccines. She said many patients believe what they see on social media over the treatment options the hospital staff recommends.

“Some don’t believe they have covid while we’re treating them for the disease,” she lamented. “Some refuse to even wear their oxygen [mask]; they argue with us about everything. … Some people are downright mean.”

Although such patients may be the exception, negative interactions take a toll that staff members said the store helps make up for.

“The hospital store is evidence that we are valued,” Peabody added. “Even when some patients tell us otherwise, every time I visit the store I’m reminded that there are people out there who appreciate me and are trying to take care of me just like I’m trying to take care of others.”

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He was fired later the same day. “Never send a patient away who’s willing to pay the clinic money,” he was told.

Silber said what happened to him then still happens today, that some dentists who don’t think they receive enough from insurance reimbursement — whether private insurance or Medicaid — have figured out ways to boost their bottom lines. They push products and procedures a patient doesn’t need or recommend higher-cost treatment plans when less expensive options might accomplish the same thing.

The pressure is more intense now since the covid pandemic cut traffic into dentists’ offices. But while most dentists are ethical, the practice of going with more profitable procedures, materials or appliances is not new. In 2013, a Washington dentist writing in an American Dental Association publication of dental costs found wide differences in the price of certain services. It said teeth whitening at the dentist’s office, for example, is no more effective than whitening strips one buys at the drugstore — and at least 10 times more expensive.

But sometimes dentists escalate to outright fraud. A recent article in the put it plainly: “Medicaid fraud is the most lucrative business model in U.S. dentistry today.”

Indeed, the ADA sees a problem. Dr. Dave Preble, senior vice president of the American Dental Association’s Practice Institute, said, “Hundreds of thousands of dental procedures are performed safely and effectively on a daily basis.” But he cited that says between 3% and 10% of the $3.6 trillion Americans spend annually on health care is lost to fraud each year. That’s as much as $13 billion of the on dental care lost to dental fraud.

Silber said he saw the X-rays of one patient after she’d seen another dentist and was shocked to learn she’d had two crowns put in when she needed only one minor filling. She was told the first crown was necessary to treat decay in one tooth, and the second crown was needed to make the first crown fit better. “She only needed one small filling. It should have cost her $100 or so,” Silber said. “Instead, the dentist convinced her to replace two perfectly good teeth just so he could make $2,400 from her insurance company.”

The absorption of small private practices by corporations, private-equity buyouts or group practices over the past two decades has increased the emphasis on higher profits. “The executive at the top tells the dentists working for them which procedures to push, like a chef tells their team of waiters to push the daily special,” Silber said. “If a dentist refuses to comply, they’re shown the door.”

One treatment patients are commonly pressured to undergo in corporate dental chains is quadrant scaling: an invasive teeth-cleaning procedure along the gum line, usually done over three or four visits. While the procedure can be helpful if a patient suffers from severe gum disease, it can erode gum tissue that cannot grow back. Dentists can charge between $800 and $1,200 for each procedure, while a standard cleaning nets them only about $100.

Dr. Michael Davis, a dentist practicing in Santa Fe, New Mexico, said some dentists look for procedures for which Medicaid pays more. He explained that Medicaid pays three to six times more for nickel-chromium steel crowns than for standard fillings, so some dentists recommend those more profitable and invasive treatments to unsuspecting patients. “The fit of premanufactured steel crowns is unfavorable and can show gaps,” Davis said, “so unethical dentists target little children who won’t notice the misshapen fit until their permanent teeth come in.”

Children who still have their baby teeth are prime targets for pulpotomies — the removal of the pulp of a tooth — whether they need them or not.

Unethical dentists also perform shortcut versions of otherwise covered procedures for a patient, while billing the insurer for the full amount — a practice known as upcoding.

Mini-implants, for example, can be easily upcoded. A standard dental implant is an artificial tooth root that dentists install to anchor a dental crown or bridge. A mini-implant, by contrast, is like “a thumbtack compared to a bolt,” said Dr. David Weinman, a dentist practicing in Buffalo, New York. In the past, mini-implants were used only to hold dentures in place, but because they are so much quicker to install and cost the dentist as much as 60% less than a regular implant, more dentists have been recommending them as a long-term solution.

“We in the dental community see a high failure rate when mini-implants are used where a regular implant is needed,” Weinman said, “but that hasn’t stopped some dentists from pushing them on patients who don’t know better.”

Then there are horror stories of dentists gone bad. In March, Dr. Mouhab Rizkallah, a Massachusetts orthodontist, for deliberately keeping his patients in braces longer than medically necessary and for deceptive billing for mouthguards. The complaint against him alleges he instructed his staff to buy plastic mouthguards at a discount store even though he knew they wouldn’t fit the patients’ teeth properly. Rizkallah then billed Medicaid $75 to $85 more than the retail price for each one and was reimbursed more than $1 million for the mouthguards alone, .

Other dental practitioners have done far worse. After a video of Dr. Seth Lookhart, an Alaska dentist, riding a hoverboard during a dental procedure , intrigued authorities found he’d been sedating nearly all his patients to cash in on the reimbursements Medicaid pays for general anesthesia. He was in prison.

The Texas Dental Board revoked the license of Bethaniel Jefferson, a dentist who was practicing in Houston, after she was found to be endangering her patients by needlessly administering general anesthesia to take advantage of the same insurance payments. She for so long the child suffered severe brain damage.

Dr. Scott Charmoli, a Wisconsin dentist, was after he was found to be using his drill to intentionally break patients’ teeth so he could bill the insurance company for crowns instead of fillings. The that he performed more than $2 million worth of crown procedures between Jan. 1, 2018, and Aug. 7, 2019 — amounting to more than 80 fraudulent crown procedures a month.

Weinman said patients can always seek a second opinion — especially for expensive treatments — and that a dentist who seems hesitant when you say you want a second opinion is worrisome. “A dentist who is confident in his or her abilities won’t have a problem with you checking a diagnosis or treatment plan elsewhere,” he said.

Other red flags: Weinman said to be wary of any dentist who seems to be reading from a script, or who pushes a treatment plan too hard or refuses to explain treatment options. “There may be several scientifically sound, evidence-based treatment plans available to a patient,” Weinman said, “and a good dentist is willing to explain your options — even the ones that may not be as profitable.”

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).