Soft elevator music almost drowns out the distant whine of the dentist’s drill as Mark Deel sits in the waiting room of The Lakes Dental Center in March 2015. Deel sips a margarita and talks football with the gregarious office manager, Brad McGonagle, in the tastefully decorated League City dental office, while Deel’s son Noah gets a cavity filled on the recommendation of Dr. Amanda Hoover.
Before Hoover went to work on Noah’s mouth, the receptionist told Deel it would cost $300.
A few minutes later, Hoover asks Deel to come take a look inside Noah’s mouth. As Deel stands by, Hoover opens Noah’s mouth and begins poking around with her fingers and silver instruments. The cavity is too deep, she tells Deel. They might have to put a crown on it. Hoover gestures to the teeth on either side. These teeth are weak too, she says, so they need crowns as well.
Deel agrees the teeth need to be fixed and goes back to the front, where McGonagle, who also happens to be Hoover’s husband, offers Deel another margarita. A dental hygienist appears in the waiting room and informs Deel his son now needs five crowns. It will cost $6,000 out-of-pocket, she says.
Deel freezes for a second, stunned. He works at an oil refinery in Texas City and has been on strike over contract negotiations for weeks. His wife, Lisa Deel, works in the human resources department at Chevron Phillips, but with four kids, her paycheck can barely cover their minimum expenses. “I don’t have that kind of money,” he tells McGonagle.
McGonagle doesn’t miss a beat. He can see Deel is a nice guy and he wants Noah to get what the boy needs, McGonagle says. Deel might qualify for a “special loan” from a lender that pays the office “right then and there,” says McGonagle. “I’ve had good luck with these guys,” McGonagle tells Deel. Hoover’s office also bills the Deels’ insurance for $6,000.
Before Deel has even thought about it, he has applied for a “care card,” a health-care credit card with an extremely low initial interest rate that soars if the card isn’t paid off within the first six months.
The loan is approved. As Deel signs the document, he hears Hoover grinding down Noah’s teeth. The dental hygienist pops up again. Noah needs a sixth crown, she tells him. Before Deel can say anything, the hygienist explains Hoover has decided to do the sixth crown for free. The Lakes Dental Center charges have already maxed out the health-care credit card.
Noah is a handsome kid with a deep tan and a sweep of black hair that make his seemingly flawless white teeth gleam. But as he was growing up, the enamel on his baby teeth was weak and he tended to get cavities. Even though Noah took care of his mouth, brushing regularly and avoiding sugary candy and gum, just as his childhood dentists had instructed, his parents weren’t surprised when Hoover found the first cavity during a cleaning.
“It was still surprising when they said he needed six crowns, because he’d just had an appointment six months ago with another dentist,” Lisa Deel says now. “But Dr. Hoover seemed so nice and personable and the office was so nice, I didn’t question her. I wondered how the other dentist had missed all this.”
Hours after his dental visit started, the drill cut off and Noah walked into the waiting room. The lanky then-eighth-grader’s face was tense, and there was a little dried blood on the corner of his mouth.
Noah went home and paced, his mouth throbbing despite the medication Hoover prescribed. He didn’t say much about the pain, just stomped his feet a lot when it hurt the most. Over the following months, Noah returned to Hoover’s office five more times to get his crowns adjusted, dental records show.
After the third visit, Hoover told him he could play on his middle school football team. A few minutes into the game, he tasted blood. He went to the sidelines and rinsed his mouth. By the end of the first half, the water had gone from pink to red. “It was gross, but I didn’t know it wasn’t normal,” Noah says now.
By the fifth visit, Noah’s mouth hurt so much he had been absent from school, he’d missed football practice and it had been months since he could comfortably chew hard food.
“Why is my son in so much pain?” Deel asked Hoover.
“This is normal,” the dentist told Deel, according to the state district court records. “It’s going to happen until we get it all done and adjusted.”
Still, his parents never seriously questioned Noah’s dental work until Lisa stopped by Hoover’s office in December 2015 to get a blister on her gums checked out and left three hours later with numb, sliced-up gums and plans to come back the next day and pay Hoover $10,000 to extract two teeth above the blistered gum.
That night Lisa Deel was in too much pain to sleep, so she started doing research and found out Hoover wasn’t even in the Deel family’s insurance network. When McGonagle called the next morning, she pointed this out and he told her he’d only said that they’d accept her insurance and he’d never said Hoover was an in-network provider. (McGonagle maintains he told Lisa and Mark that Hoover was not in the family’s insurance network.)
Dr. David Columbo examined her the next day. Her gums were so swollen, he couldn’t quite tell what Hoover had done, Columbo told Lisa, but the blister on her gums was related to her clogged-up sinuses. (Ultimately, one of the teeth Hoover had advised extracting was infected, but the problem was solved with a root canal at a fraction of the cost, Lisa says.)
Lisa Deel pulled Noah out of school to have Columbo examine him. “I don’t know how to tell you this, but I don’t see any evidence here that he needed these crowns,” Lisa Deel says Columbo told her. “Maybe fillings, but not crowns, and these were done wrong. They’ll have to be replaced.”
According to state district court records filed in Galveston County, Columbo stated that “every one of the crowns done just months ago have short margins or recurrent decay under them.” The documents also allege that “Columbo [told] Lisa and Noah that the crowns need to be replaced in the next few months and furthermore that there [wasn’t] any indication that Noah needed five to six crowns. Columbo also [gave] Lisa contact information for the Texas State Board of Dental Examiners and [encouraged] her to file a complaint.”
Shortly after Noah’s visit to Columbo’s office, the Deels learned Hoover had charged them for Noah’s dental work, but had also “turned in a claim, for the $6,000 already paid, to the Deels’ dental insurance carrier. Soon after, Lisa [received] a notice from her dental carrier denying Hoover’s claim because Noah’s crowns were ‘necessary for reasons other than treatment or traumatic injury,’” according to state district court documents.
The Deels contacted Jim Moriarty, a Houston lawyer with years of experience in dental cases, and decided to sue. The case was filed on August 2 in Galveston County District Court last week. Hoover has not yet responded to the allegations in court. Moriarty had Dr. Jeff Allen, a Houston dentist who has been practicing for more than 40 years, examine Noah’s dental records and his mouth. In a report Moriarty shared with the Houston Press and in a subsequent interview, Allen concluded all but one of the crowns were unnecessary.
Hoover was overcharging, the Deels maintain. However, the Texas State Board of Dental Examiners’ rules governing what dentists charge, what treatment they recommend and even how they bill patients are based on “standards of care” and are very loose, which allows anyone who chooses to make the most money he can, Moriarty contends. The rules vary from state to state, but not by much.
The dentist review system in Texas does have its supporters, who declare that by far there are more good dentists than bad out there. But consumers get little help in sorting out what kind of dentist they are dealing with, particularly since the name of any dentist under investigation is withheld from the public and never revealed unless the dentist is formally disciplined.
“The ultimate responsibility is on the consumer,” says Susan Schade, director of dispute resolution for the Houston Better Business Bureau. “The dentist has the right to charge what he or she thinks is fair market value for services, and the patient has the right to shop around. It’s the patient’s responsibility to make sure they get the best value; it’s not on the dentist.”
When contacted by the Press, Hoover declined to discuss any specific cases. Broadly speaking, she says, her job is to make people happy with their teeth. “I spend a lot of time with people, and we spend a lot of time figuring out what they want long term, short term; there are so many ways to approach a problem,” Hoover says. “From there they can do nothing, they can do everything and they can do anything in between. I get them what they want, what they’re comfortable with.”
Her husband was more forthcoming as he strode through the hallways of Hoover’s practice in late July, past a number of empty, darkened offices, to his own. “This is strictly a money thing,” McGonagle said as he settled into his chair, flicking on a fan and explaining he doesn’t run the air-conditioning to save on the electric bill. “My wife knows the truth and I know the truth — the kid had bad teeth. But nobody forced them to stay here and get the work done. That was their choice.”
Moriarty has been representing people and their claims against dentists and dental corporations for about a half-dozen years. “It’s mainly about trust. We’re taught to trust these people in white coats and to believe what they tell us, so it gets very hard for people to ask if they’re trustworthy,” Moriarty says.
Dentists today get out of school with more than $200,000 in student loan debt because over the past 30 years, the price of dental school has shot up, driven by demand and inflation, and state funding has been slashed, and the extra cost has been passed on to students, according to Dr. Eric Solomon, a professor at Texas A&M University Baylor College of Dentistry.
Meanwhile, corporations are not legally allowed to own dental practices, but in the 1990s, these entities found ways to act as dental management teams, indirectly running practices without technically owning the operations, Allen stated. (Various other dentists working in Texas and other states confirmed this.)
“They changed the entire game,” Allen says. “The corporations came in with all this money, and they were so big they could afford to be cheaper than the private practices, to compete. Today there’s a major influence in the profession, because the people who work in these systems are taught to think of volume and numbers.”
Insurance companies have also helped shape dentistry because insurance adjusters have kept the annual coverage rate cap between $1,000 and $1,500 since the 1970s, without adjusting for inflation, according to the American Dental Association. “There are so many financial pressures on dentists today. It’s getting much harder to make a profit than it used to be,” James Quiggle, spokesman for the Coalition Against Insurance Fraud, says. “Most dentists are honest and ethical, but the financial pressures to make a go of it, whether as a sole practitioner or as part of a corporate entity, can push dentists who are on the edge to do ethically questionable things just to try and survive.”
Insurance company officials have also used the fact that they offer networks of potential patients to negotiate low payment rates for services, Quiggle says. To make money, dentists have to perform more services or get patients to agree to pay for more services out-of-pocket.
“It’s a function of debt. People are starting up their practices with huge amounts of debt, and they need to find a way to get out of debt and subsidize their practice, so they get a little less discriminating,” Dr. Jeffrey Camm, a pediatric dentist in Washington state, says. Camm got so frustrated seeing patients with unnecessary dental work that he wrote an essay in 2013 that was published in The Journal of the American Dental Association. “You know, dentists rate right up there with the clergy and nurses as trusted individuals. Mostly people honor that, but sometimes people abuse it.”
Another Houston-area case — one that has become infamous — involved four-year-old Nevaeh Hall’s trip to the dentist. When Nevaeh went to Dr. Bethaniel Jefferson’s dental office in January 2016, she was giddy with excitement, her mother says. On a previous visit, she’d taken home a backpack full of dental care supplies, and she loved brushing her teeth with her SpongeBob SquarePants toothbrush. On this second visit, as her dental records show, the plan was to extract her damaged baby front teeth — she’d fallen down face first shortly after the teeth came in — and put crowns on the teeth on the right side of her mouth. Jefferson had explained to Nevaeh’s mother, Courissa Clark, that putting the crowns on now would take time, Clark recalls, but doing so would help slow the decay in the child’s teeth.
Clark thought it was strange that Nevaeh already had so many cavities, because her daughter was obsessed with oral hygiene, but Medicaid was covering the work. Clark and her husband, Derrick Hall, planned on putting Nevaeh in Head Start, and Clark was intent on getting her child’s front teeth fixed before Neveah entered the program in the fall. “You know how kids can be about that stuff,” Clark says now.
According to court records, after about 90 minutes, Clark and her husband noticed a whining sound coming from the room where they’d left Nevaeh with the dentist.
Hall went back and saw it was his daughter making the noise, but Jefferson said everything was fine; Nevaeh had just woken up and gotten scared, according to interviews, a report from the Texas State Board of Dental Examiners and state district court documents. Then the shaking started, and the dentist again reassured the parents Nevaeh was fine; she just needed to rest, according to state district court documents. Clark says the dental staff laid Nevaeh down on a cot and locked the parents out. Then an ambulance showed up and took her to Texas Children’s Hospital, where the parents learned she’d been severely overmedicated and had suffered brain damage, according to a report from the Texas State Board of Dental Examiners. She was given “large doses of anesthetic and sedatives,” and there were “warning sounds and visual indications which showed that for a period of five hours Nevaeh’s brain suffered from a severe lack of oxygen.”
The Press has attempted to reach Jefferson for comment, but calls and messages were not returned.
The doctors showed Clark the scans of Nevaeh’s brain. Clark stared at the marbled image of it. She says the doctors explained that the bright parts showed where there was still activity, and the dark sections showed where the lack of oxygen had damaged her brain. There was a single spot about the size of a period, just a dot of color. The child who’d been learning her colors, her numbers, the alphabet — which she called “the C-B-As” — was gone. “My husband wanted to have her scanned again to see if she’s improved, but I can’t. I don’t want to know,” Clark says. “I didn’t get a copy of the scan, but I could draw it for you now. I see it whenever I close my eyes. I see it in my dreams at night.”
Once they knew Nevaeh would live, the question turned to what had happened to her that day. Clark called Moriarty’s office, and when he heard Clark’s story, he agreed to take their case. Exams by other dentists say the work performed on Nevaeh was improperly done, according to an analysis of the records by Dr. Roger Byrne, a Houston dentist hired by Moriarty to review the case, and state district court documents.
Clark filed a complaint against Jefferson with the Harris County Sheriff’s Office shortly after the incident, but no charges have been brought against Jefferson, though Harris County District Attorney spokesman Jeff McShan says the district attorney’s office is keeping tabs on the investigation. Two weeks ago, Clark and Hall filed in Harris County District Court against Jefferson, who has not yet responded in court to the allegations. “I’m trying to do what I can to make things right for my baby, but I don’t know what else I can do,” Clark says.
Nevaeh is like a baby now. Clark holds her in her arms and she coos and laughs, cries. At one point, the doctors told Clark that even this much would be impossible. Nevaeh sits in Clark’s arms, her head cradled against her mother’s breast. Everything stops for a moment when Nevaeh giggles. “What is it? What are you laughing at?” Clark says, cuddling the girl. “I’m trying to be at peace with this, but I can’t help it. I believe she’ll be a miracle, that she’ll be whole again.”
When Amanda Lightfoot got the bill for her dental work, she burst into tears right there in Hoover’s waiting room.
It was fall 2014 and Lightfoot had come in just to get two crowns replaced. The Lakes Dental Center was a red brick office building with large windows looking out onto a man-made lake. “It looked like a dentist office. A little fancy but basically just a dentist office,” she says. The man up front told her the practice accepted her insurance, and she made an appointment. “It wasn’t even a big deal. It was just a crown,” she says.
Hoover examined her mouth and advised Lightfoot that a baby tooth that had never fallen out was abscessed and needed to be removed immediately. Hoover also recommended Lightfoot have two teeth extracted and replaced with implants. “I’m a surgical nurse, so I took it seriously when she told me there was impacted bone. I didn’t even think to question it,” Lightfoot says now.
Hoover removed the bridgework and the tooth. It was only then that Lightfoot found out that while Hoover did technically accept her insurance, she wasn’t in her insurance network. On top of that, the receptionist informed Lightfoot she needed to come up with $5,000 to cover the deductible. The receptionist told her she could apply for a health-care credit card, but Lightfoot called her stepfather and he lent her the money.
She went home with a hole in her mouth where the tooth had been, and says Hoover told her it would cost about $20,000 to finish the work. Lightfoot cried all night. “I’ve always been really self-conscious about my teeth. I had this hole in my mouth and I wanted it fixed, but there was no way I could afford the cost,” she says now.
The next day Lightfoot’s hospital co-workers told her to go see another dentist. When she got to the new dentist, though, Lightfoot found out Hoover’s office had already billed her insurance for more than $8,000 worth of dental work, using up her dental insurance for the year. “The insurance company had already paid, and insurance said they couldn’t get the money back unless Dr. Hoover sent in a form saying she hadn’t done the work she’d billed the insurance company for. I called Dr. Hoover’s office and they would never send in the paperwork,” Lightfoot says.
Ultimately, Lightfoot had to wait until her insurance restarted in 2015 to finish the work Hoover started. “It was frustrating because I’d told them I’d had some bad dentist experiences as a kid, that this made me nervous, and they were all smiley and soothing, and the next thing I know, they’re taking all of my money,” she says. The next dentist she went to charged her less than $10,000 to put in the implant.
McGonagle answered Lightfoot’s complaint to the Better Business Bureau with a detailed response in which he acknowledged that Lightfoot portrayed her dental issues accurately. The patient, however, was quoted only $16,346 worth of work, he wrote; her insurance company was billed for only about $6,400 worth of dental work for the day. He closed his response by noting that Lightfoot still had a $4,400 credit and $779 could be billed back to her insurance company. All she had to do to collect was sign a release agreeing to “the discontinuation of all existing and/or future complaints with any agency or board.”
Hoover declined to comment on any of her cases, citing medical privacy laws, but McGonagle forcefully dismissed all the patient’s claims during an interview with the Houston Press. He also explained how Hoover’s business works.
“We don’t do the small stuff. We do big cases, and because of that, we usually ask the patient to pay up front,” he said. “We’re a boutique practice. We will [do a] treatment plan for the ‘Hollywood Smile’; that’s mainly what we do. People spending $25,000 or $50,000 to get those perfect teeth. We do whatever they want us to do. If a patient wants a pack of smokes, I go get them because it’s all about service here.”
Dentistry can be highly subjective, he pointed out. “You take ten different dentists, have them all look at the same mouth and you may get ten different treatment plans. Everyone has their own approach,” he says.
He dismissed the idea that his wife has advised anyone to get dental work he or she didn’t need. Yes, they’ve had their hard times through Hurricane Ike, the Great Recession, the NASA layoffs and the current oil downturn, but the business is doing well.
Yes, there is more than $140,000 in federal tax liens against the practice, as is listed in Galveston County Court records, but McGonagle said this is simply because he fell behind in payroll taxes.
They also owed more than $3,000 in Galveston County property taxes and more than $3,000 in back taxes to Clear Lake Independent School District, also listed in Galveston County District Court records, but McGonagle said he plans on taking care of those tax bills shortly.
“I get it,” he said. “In other shoes, it could look like we don’t have the money, like we’re not doing well, but it’s not true. What you’re seeing here is a witch hunt. This is a good dentist getting attacked for nothing.”
Lightfoot also went to the state board of dental examiners about Hoover, she says. The board investigated the case for more than a year, providing Lightfoot with status updates every couple of months, she says. In June, the state board informed Lightfoot that Hoover would not be disciplined. Hoover’s record is currently unblemished.
This is how most of these cases go, Moriarty says. Dentists are regulated primarily by the state dental boards, the entities that have the power to investigate and discipline a dentist who has done wrong. Unless a board decides to reprimand a dentist publicly, the odds are good the public will never know there has even potentially been an issue, he says. “The board keeps this information completely confidential [as required by state law], and these investigations are only made public if the board decides to discipline someone. After all, if accusations are made public, that hurts the dentist’s reputation and it may be found that those accusations are completely untrue,” Texas State Board of Dental Examiners spokeswoman Lara Anton says.
University of Houston law professor Allison Winnike maintains dentists are extremely well regulated, that the problems are small compared with the number of excellent dentists in the profession. “The dental board isn’t necessarily a system for remedy, but it does regulate dentistry and preserve the quality of the profession. They’ll look at a complaint and maybe they’ll think the dentist needs some retraining. If it’s terribly bad, maybe they pull the license,” Winnike says.
Critics of the state boards maintain the boards keep complaints private because they’re focused on protecting dentists. “People assume dental boards are out there to protect the public and to make sure the dentist that comes out of school can treat you. People assume these boards will be there to protect you from any unscrupulous behavior in the industry, but that’s just not the case,” says Debbie Hagan, a Kentucky homemaker and grandmother turned dental patient rights activist who writes a blog detailing various issues with dentistry across the country.
Dr. Bethaniel Jefferson, the dentist for Nevaeh Hall, has a history of infractions with the state board starting in 2005, when the board reprimanded her for failing to enter patients’ vital signs in her records, according to board documents. She paid a $1,000 fine and took continuing education classes. In 2012 Jefferson again ran afoul of the board for not meeting standards of care while sedating a patient. She was fined $3,000 and once again ordered to take continuing education courses, but kept her license.
However, in January 2016, the State Board of Dental Examiners moved quickly and decisively, finding that the “continued practice of dentistry by Bethaniel Jefferson, D.D.S.…would constitute a clear imminent or continuing threat to a person’s physical health or well being.” After an emergency meeting over what had happened to Nevaeh, the board suspended Jefferson’s license temporarily.
“That’s the problem. To get a board’s attention, the case has to be particularly egregious. Otherwise nothing happens,” Moriarty says.
In March 2016, 14-month-old Daisy Lynn Torres was at Austin Children’s Dentistry to have two cavities filled. Shortly after Daisy was put under anesthesia, Dr. Michael Melanson told Daisy’s mother, Betty Squier, the child needed six cavities filled. Soon afterward, Squier was told there were problems during the procedure. Daisy was declared dead at a nearby hospital about two hours later.
In July, Robert Williams, a forensic dental examiner, stated in a report commissioned by the Travis County Medical Examiner’s Office and first obtained by KXAN TV that Daisy may not have needed any of the dental work in the first place. “One can only speculate as to why any treatment was performed considering no indication of dental disease or pathology was seen in the dental radiographs in the dental visit dated 3/29/2016,” Williams wrote. The X-rays from before Daisy’s dental work show no disease, but the X-rays done after her death show four teeth that appear to have been prepared to have stainless steel crowns placed on the teeth, he noted.
The autopsy report from the Travis County Medical Examiner’s Office says the cause of death was anesthesia. Melanson contended there were dental issues that needed to be dealt with, according to the autopsy report, but Williams disagreed, noting the girl’s dental visit in July 2015 didn’t show any signs of decay on the child’s teeth. “It is possible that the partially erupted teeth may have had a congenital enamel defect but not necessarily requiring treatment with a child of this age,” Williams wrote. “No evidence that the child was in any type of pain was ever notated in the dental record and no pulp vitality test was ever performed.”
In the wake of the forensic dental report, Austin Children’s Dentistry suspended Melanson “indefinitely” until the Texas State Board of Dental Examiners concludes its investigation, according to a statement issued by the clinic. Melanson’s attorney, Jason Ray, explained away the lack of decay on Daisy’s teeth. “By the time the forensic odontologist evaluated Daisy, all evidence of dental disease had already been removed by the dentist, as expected,” Ray told KXAN. Melanson’s license is still good with the Texas dental board.
Across the country, the repercussions for a dentist who breaks the law or the rules are not reliable, Hagan says. A dentist can maintain licenses in various states, but there’s no national registry to track all practicing dentists, she says. States must report any health-care disciplinary actions to the U.S. government’s National Practitioner Databank, but some states are not even required to check this databank before issuing a license.
Having a record doesn’t preclude a dentist’s getting a new license, either. In 2002, California issued a dental license to one dentist who had served prison time in Arizona for cheating insurers and was banned from practicing in that state. He surrendered his license in 2014 after state officials learned he’d been illegally sedating patients, which resulted in one death. “There’s absolutely nothing to stop a board from still issuing a guy with a prison sentence a license,” Moriarty says. “It’s frustrating because these are people in positions of such trust, that can be so important to a child, to someone’s life, and there’s no guarantees that they’re trustworthy.”
For people like Moriarty and Hagan, the fight against bad dentistry is in many ways a personal battle, one that evokes longstanding memories.
As a child, Moriarty had cavities eating away his two front teeth and his family never had the money to fix them. “I often wonder how my life would have been different if I’d been able to get to a dentist,” he says. “I remember going to high school and being so embarrassed. I feel like it might have been a very different life for me.”
Hagan started gathering information in 2007 on dental practices and the law, and how the profession is governed, after her then-four-year-old grandson was strapped to a papoose board during a procedure, in order to restrain him. But Hagan says what really drives her is her own memories of being a kid with bad teeth. By the time she started school, all but four of her baby teeth were capped in silver.
“I wouldn’t smile in the class pictures, because of all the metal. Standing up in front of the class was torture because I knew they saw me flashing a mouth full of silver every word I spoke,” Hagan says. “I don’t think most people realize how important it is, that you have to have your teeth in working order in order to thrive. You don’t want to be different, especially when you’re young and going to school. It changes kids. It changed me.”
Noah never told his parents how much each of those visits really hurt. When he got home, he’d skulk off somewhere so his two older brothers wouldn’t see him cry. He didn’t want to worry his mom, he explains now. “I have really high pain tolerance. I broke my arm and I didn’t even cry. It hurt, but I could handle it,” he says now. “Going to the dentist, though, she’d grab onto the crowns and just yank at them. The pain was unreal. I kept wondering how this could hurt so much more than a broken arm.”
Lisa Deel clenches her jaw when she speaks about Hoover. “Mark and I have been so careful about who we trust our kids with. We don’t let people come around our family without checking them out carefully. We made a mistake here, and it’s so frustrating because Noah is the one who has to deal with the consequences.”
Noah grins a lot and his teeth are rectangular, blazing white and perfectly straight. He gets compliments on his smile all the time. “People say I have such beautiful teeth,” Noah laughs, shaking his head. “They have no idea.”
Each tooth Hoover drilled into has been compromised and will need extensive work in the future, Allen says. “He’s a patient for life.”