Telling the story of The Rose has always meant fighting the prevailing misconception that the poor could access healthcare anytime they wanted, either through the county hospital or, if they have cancer, through M.D. Anderson.
People would say, “Anyone can get public health care.” That’s a true statement, but the cost of services is dictated by a person’s income. If you happen to be totally indigent, you are eligible for free services. Heaven forbid that a person attempt to stay off the public dole and try to earn a living. The ultimate irony was that totally indigent women received the full range of care -- from mastectomy to chemotherapy to radiation therapy to reconstruction -- all free of charge; while the working poor got only what they could afford.
No insurance and get into a premiere hospital without money? Not likely, especially if you made more than $3,000 a year and lived in Houston which was the eligibility level at some hospitals. According to the State edicts, the county hospital was the approved facility for residents of Harris County. Folks from the rest of the state looked to Galveston’s public health system for help. Oh, it’s true the occasional uninsured patient would get into a clinical trial at a major institution, but she had to have one of the wild types of cancer that matched the trials.
The maze of rules and regulations grew more complex and changing criteria for eligibility was maddening. Remember, in Texas Medicaid was virtually non- existent, saved only for children and pregnant women; for the most part it still is.
Connie was one of Dixie’s clients. She referred Connie to a public hospital for her mastectomy and chemotherapy treatments. Dixie knew about Connie’s financial struggle. She and her husband operated a small plant nursery that could barely eke out a living for their family. Unfortunately, the profits were gobbled up by the medication expenses needed for her recently diagnosed diabetic husband.
Any hopes of finding another job were squelched when she weighed it against the time and expense involved in caring for the special needs of a bed-ridden handicapped child. On paper, however, hers appeared to be a much different story. The business showed a profit for two out of the three years in the information she submitted when applying for public health. That and the fact that she was buying a home put her in the 100% payment range for services. Back then, Dixie didn’t know about these quirks in the public health system; none of us did.
So Connie carried her little referral paper to the hospital, finished the approval process and went in for her mastectomy. Before she knew it she received her first bill for $5,000. Then she was told that chemotherapy was going to cost $400 every three weeks. She’d already signed an agreement with the hospital to pay against her account which grew larger with each lab test or follow-up consultation. Before they would schedule her appointments for the chemotherapy, she was going to have to come up with the money.
When Dixie received one of those form letters sent to referring physicians, advising her that her patient was determined to be non-compliant since she had not returned for treatments, she called Connie.
Hearing Connie talk was disheartening. She was more than a little angry about the whole set up, and she had no intention of going back. The money and the hours and hours of waiting were taking a toll. She had to pay for someone to stay with her child each time she went for an appointment which might be rescheduled or would take all day. The time she had been hospitalized had really hurt what was left of the business. She simply didn’t have the money and was fighting to keep food in the house. To top things off, her husband had a heart attack during this time and couldn’t help.
The hospital suggested she get a second mortgage which she couldn’t have gotten if she’d wanted it. We’ve since learned that some hospitals strongly encouraged folks to take another mortgage on their homes to pay for treatment. For the patient who is terrified for her life, it seems the only solution.
Connie had decided she would just have to take her chances and hope the mastectomy got all of the cancer; she would do without the chemotherapy. Dixie tried to convince her otherwise, offering to call the hospital and try for new arrangements. Dixie knew Connie really needed the chemotherapy and asked her if she understood how important the treatments were?
Connie’s parting words hung in the air. “Dr. Melillo, don’t you understand,” she retorted a bit too sharply. “If I’d had an extra $400 a month to shell out, I would have had insurance.”
As always, it’s a matter of money … for our patients needing help… and for The Rose as we try to help them.
This memory is one of 25 short stories written by Dorothy Gibbons, the Co-founder and CEO of The Rose, a nonprofit breast cancer organization. She and Dr. Dixie Melillo received the 501C3 documents for The Rose in 1986. A memory will be shared daily, culminating with number 25 on the day The Rose celebrates its 25th anniversary November 10.
© 2011 Dorothy Gibbons. All rights reserved.
No comments:
Post a Comment