VACAVILLE, Calif. — His jaw clenched beneath a blue surgeon's mask, Opanin Gyaami jerks his right arm and pulls out a prize: the decayed tooth of patient Larry Butler, also known as state prison inmate J22312.
By the time he is done, Gyaami's smock and mask are spotted with the inmate's blood. He gently pats Butler on the shoulder and wishes him well.
The 71-year-old dentist reports to the state prison in Vacaville day after day, long past retirement age. He wishes he could have hung up his drill and forceps years ago, but he's still paying off a student loan.
After borrowing $50,000 in the 1980s and ignoring payment notices, Gyaami owes more than $500,000 with penalties and interest. The Justice Department took him to court and is seizing $3,000 from his paycheck each month.
Gyaami doesn't expect any sympathy; he knows he's at fault and has added to his problems by falling behind on his income tax. He acknowledges he made some bad decisions along the way.
"I don't want to sound like I'm blaming someone else for my woes," he said. "If you take a loan and don't pay it, you're responsible. It became so overwhelming. I got scared, and it didn't go away."
Student-loan debt in the United States has surpassed $1 trillion. A record number of loans are in default, according to several recent reports, and lawmakers in Washington are pushing for reform to make it easier to discharge some of the debt in bankruptcy.
Although economists' concerns about this debt are typically focused on the young and newly employed, about 2.2 million Americans over age 60 collectively owe more than $43 billion in student loans, according to the Federal Reserve Bank of New York. Many of those loans are in default.
"People think they're kids, but I'd say half the people who come here are over 40, and we have a lot over 60 and some over 70," said Elena Ackel, a senior attorney with Legal Aid Foundation of Los Angeles, which often advises people with student loan debt. "It just doesn't end because of all the fees and everything."
By the time Gyaami graduated from Loma Linda University in 1983 with a degree in dentistry, he had taken out five loans to pay for his education, including $50,000 from the federally guaranteed Health Education Assistance Loan program.
The special loan program, offered from 1978 to 1998, lent $4 billion to 157,000 aspiring doctors, dentists, podiatrists, chiropractors and other health professionals. The Department of Health and Human Services, which oversaw the loan program, reports that 935 of the borrowers are in default, owing $115 million collectively.
After graduation, Gyaami owed about $100,000 and made monthly payments to Loma Linda, none of which was applied to the $50,000 loan. Those payments, he later discovered, should have gone directly to the bank that issued the loan.
When late notices started to arrive, Gyaami ignored them. "There was nothing I could do about it," he said. "I was behind with my business."
Gyaami admits he's better at dentistry than business. He didn't realize how dire the situation had become even after hearing from the Justice Department, which sues borrowers who default on federally insured student loans. Gyaami's $50,000 loan had grown to $195,000 with penalties, interest and fees.
He continued to discard the collection notices. He said he couldn't afford to pay. By June 2010, the $195,000 debt had jumped to $522,214.
The dentist offered to pay $150,000 to settle the suit and close the loan — the money would come from taking a second mortgage against the family's house — but the Justice Department rejected it. A department representative declined to comment on Gyaami's case.
In December 2010, the government reduced the debt to $400,000 and agreed to collect $3,000 a month from his monthly checks, Gyaami said. He thinks it will take more than 10 years to pay it off.
"It's not easy to deal with," Gyaami said. "It looks like I'll have to work until the day I drop off and die."
Born and raised in Ghana, Gyaami was one of 12 children. He studied theology in Nigeria before moving to the United States in 1970. At Andrews University in Michigan, he met his wife, Elizabeth, and they moved to California. He earned a master's degree in public health at Loma Linda University and entered dental school.
Gyaami thought that his dental career would be lucrative and that he wouldn't have trouble paying off his student loans. He opened his practice in Grand Terrace, near San Bernardino.
But he struggled to turn a profit, netting an average $15,000 a year after payroll, rent, supplies and a loan for dental equipment, which was eventually repossessed. Then an employee embezzled about $15,000, which he didn't report to the police.
"She had two children. I couldn't bring myself to prosecute her and let her go to jail," he said.
In 1994, he closed the practice and took a job in the state prison system, first in Blythe and then in Vacaville at the California Medical Facility, where he's worked more than 15 years.
Even though his income increased at the prisons, he still struggled. He and his wife, who worked at the Vacaville prison as a dietitian, put their five children through private schools. Each month they tithed 10% of their income to their church.
He and Elizabeth are devoted members of a Seventh-day Adventist church, where he serves as an elder. "I've been able to get through all of this because of God," he said.
Gyaami treats 30 to 40 prisoners a week, under the watchful eye of uniformed guards. Many of his patients are violent felons serving time for rape, robbery or murder.
As an experienced dentist, Gyaami is among the highest-paid state employees in California, making about $275,000 per year.
"I'm completely broke, even though I make all that money," he said. "The good news is I'm strong enough to practice. And I love doing dentistry, even in the prison."
Since 2008, Gyaami has fallen behind about $120,000 in federal taxes and pays $6,000 a month to the Internal Revenue Service on top of the $3,000 to the Justice Department. His monthly paycheck, after deductions, is barely enough to live on, he said.
Other medical professions have tried to address this problem among its members. The Osteopathic Medical Board of California, for instance, has suspended the licenses of osteopaths who fail to repay their student loans. Donald Krpan, executive director of the board, defends the policy.
"When they don't pay the loan, the federal government comes in and pays the loan. At that point, you and I as taxpayers pay the loan," Krpan said. "It's an aggravation to those of us who borrowed money and paid our loans."
Despite the lingering debt, Gyaami and his wife live a comfortable lifestyle. One year ago they took a two-week cruise in the Caribbean that cost about $4,000, said Gyaami, who called it the most luxurious vacation they had ever taken.
"We forgot about everything and relaxed," Gyaami said, "even though in the back of our heads we knew we were coming back to pay for it."
They live in a 4,000-square-foot home in Vacaville, which Elizabeth purchased new in 2001 for $429,500, according to property records. In 2010, she took efforts to make the home more difficult for creditors to seize by transferring its deed to a corporation she started, Eternal Enterprise Corp.
Gyaami and Elizabeth have been married 41 years. Four of their children are doctors, and each graduated with college debt. He said he hopes they learned from his mistakes.
One of his sons recently negotiated a good deal before he took a new job. His employer paid off his student loans.