Many patients waiting until symptoms get serious to be treated

[okarol]

Jan. 17, 2009
Copyright © Las Vegas Review-Journal

HEALTH CARE: Crises drive doctor visits

Many patients waiting until symptoms get serious to be treated

By ANNETTE WELLS
LAS VEGAS REVIEW-JOURNAL

The man came into University Medical Center last week with symptoms associated with an inoperable brain tumor.

Dr. Dale Carrison, head of emergency services, discussed options with the patient, hoping to at least provide him some relief.

"He didn't want me to do anything because he knew he was dying,'' Carrison said. "I told him, 'You need to know what you're alternatives are, that your quality of life the next six months or so could be better than being not functional.'

"He didn't care. He didn't want his wife stuck with bills after he died."

Carrison, an emergency room physician, says the scenario illustrates a trend that's becoming too common in Southern Nevada: UMC's emergency department and Quick Care Centers are seeing an influx of patients who wait until their health has reached crisis levels before seeking care.

As a result, patients are turning to the county hospital "sicker" and in need of more expensive emergency care, Carrison said.

This situation, Carrison and other Southern Nevada health care professionals say, is only going to get worse as the state's economy founders, more people become jobless and lose their health insurance, and medical providers refrain from providing services to the poor because of low reimbursement rates.

"Everybody's coming in sicker,'' said Dr. Cory Russell, medical director of UMC's Quick Care at Craig Road near Losee Road.

In particular, Russell said patients are coming in with high blood sugar levels.

"They haven't taken their insulin because they couldn't afford prescription refills,'' he said. "They didn't want to go to their primary care physician because they didn't want to pay the co-pay.''

When patients with chronic conditions like diabetes run out of their medications and roll the dice, they run the risk of becoming seriously ill or dying, Russell said.

"These are the types of conditions that primary care physicians should be treating. People should not be waiting until the last minute for care,'' he said. "Patients are telling us that they've lost their jobs. Some are saying it's their last week of health insurance coverage so they need to get medications refilled before it ends. It's a pretty common thing right now, and I don't have an answer."

Additionally, Russell said common winter ailments such as sore throats and fevers are turning into more serious problems such as pneumonia. People have allowed these symptoms to linger longer than a week or 10 days. By the time they come to a UMC Quick Care they need the emergency care, he said.

"We're sending those patients to the emergency room,'' he said. "The emergency room isn't supposed to replace the primary care physician.''

Russell said this trend began in the fall and hasn't slowed.

Carrison said UMC's emergency room "actually has young people with pneumonia, and because they wait so long to get treatment, they are septic."

"Some die within a day,'' he said.

Carrison said sepsis occurs when infection spreads and attacks every organ in the body.

Though he couldn't provide statistics, Carrison said upper respiratory infections, abdominal pains, and chronic illnesses including congestive heart failure, are plentiful in the emergency room.

Southern Nevada's only public hospital's emergency room is also seeing more mentally ill patients, people who need dialysis and patients who have cancer, he said.

All of those increases could be attributed to the state's budget shortfalls.

Late last year UMC's administration cut more than a dozen services in an effort to save money. Among services cut were kidney dialysis and outpatient oncology.

Some of these very patients, who are low-income and depended on these services, are now waiting until they can get the care in an emergency situation, Carrison said.

Though the hospital can't turn those patients away because of the federal Emergency Medical Treatment and Action Labor Act, or EMTALA, there's really no source to recoup the costs of care, Carrison said. As a result UMC is going to incur debt, he said.

Under EMTALA any hospital that bills Medicare must provide care to anyone seeking medical attention in emergency rooms.

The problem isn't just UMC's. Other Las Vegas Valley hospitals are seeing influxes of "sicker" patients as well as patients without health insurance.

"We have seen several cases where patients are seeking treatment later, after symptoms have worsened, because they did not want to incur a co-pay by seeing their family doctor at the onset of their condition,'' said Naomi Jones, director of marketing for Spring Valley Hospital Medical Center.

Gretchen Papez, a spokeswoman for Valley Hospital Medical Center, said walk-in traffic has increased but not to the level seen at UMC.

Papez said the hospital is carefully screening patients to determine if they have a non-emergency issue. If a patient with a non-emergency issue wants care in the emergency department, they are asked to work with patient service representative to make financial arrangements.

"We collect the deductible; if they don't have insurance, they must make a minimum deposit,'' she said in a statement. "If patients decide they don't want to receive care in the ER after being informed of their non-emergent illness, we provide a list of non-emergent providers who can assist them.''

The Sunrise Health System, which operates Mountain View, Southern Hills and Sunrise hospitals, has documented an increase in uncompensated care in recent months.

"I think people are going to wait longer for care and they will start showing up in the emergency department,'' said Rob Dyer, a spokesman for HCA's Far Western Division.

Dyer said the state's jobless rate isn't going to help matters.

When people lose jobs, they typically lose their accompanying health care benefits, Dyer said. And in cases where workers are laid-off and offered COBRA benefits many may not be able to afford them, he said.

The federal COBRA law requires many employers to allow former workers to remain in the employer's group health plan up to 18 months. The former employees have to pay full costs of coverage plus an administrative fee. Workers may continue the coverage for themselves and their family members.

However, according to a study by Families USA, a consumer advocacy group that focuses on health care, COBRA premiums are unaffordable for most laid-off workers.

The report, released last week, says the national average cost of COBRA, plus a 2 percent fee, is $4,656 a year, or $388 a month. For family coverage, the cost jumps to $12,823, or $1,069 per month.

In 2008 the average Nevada unemployment benefit per month was $1,261, the report says. The average COBRA monthly premium was $338.

For a family of four the COBRA premium in Nevada jumped to $915 per month.

Dyer said it might be difficult for the recently laid-off to pay COBRA premiums on top of housing, food and other life necessities. Given that situation, some will likely forgo COBRA in favor of being uninsured.

As that happens area hospital emergency rooms will experience an increase in uninsured patients, and these patients will come in with more serious problems because they've waited.

"The sad thing is the flu season hasn't even really hit yet. When and if it does hit in February and March, it is going to be interesting,'' Russell said. "Our emergency room can only take so much. It is already an internal disaster.''

Contact reporter Annette Wells at awells@ reviewjournal.com or 702-383-0283.
 
 
 
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[Sunny]

I remember having to pay $1,000 per month for my family of four under COBRA when my health insurance ran out after being on disability. Thank god for my husbands health insurance which covers even my pre-existing condition of kidney disease.

[Rerun]

People just can't afford to get checked out.  My friend was having an anxiety attack in the mall so the People called an ambulance and took her to ER.  They did nothing and her bill was $6,000.  No medical insurance.  Now they are facing bankruptcy.

[RightSide]

After I got laid off, I was forced to purchase my own individual health insurance policy.  All I could afford was a high-deductible policy, whose premiums were "only" $4,000 a year.

At the time, I figured that a high-deductible policy made sense, because I was a healthy guy and hadn't needed expensive medical treatment before.  But years later, I was stricken with ESRD.  The procedure to insert a hemodialysis catheter into me cost $10,000, and my policy had a $7,000 deductible on surgical procedures like that one.

I asked the insurance representative whether I could lower my deductible in exchange for paying a higher premium.  She replied that could be done, but only if I could guarantee that I wouldn't file another claim for another surgical procedure within six months of lowering my deductible.  Since I am planning to have the fistula procedure in the next month or two, that was that.  With all my health problems caused by ESRD, I can't guarantee I won't need surgery in any six month period.

Some health care reform advocates have been pushing high-deductible policies for seemingly healthy persons as a way to control health care costs.  But they are a big risk--you never know what time bombs are ticking away inside you:  Cancer, heart attack, or (in my case) kidney failure.  And then you're stuck paying the huge deductibles.