Guaranteed Healthcare

From the Musekegon Chronicle, Muskegon Michigan, Wednesday June 20, 2007: Health-care system leaves uninsured man in limbo Wednesday, June 20, 2007By Jeff Alexander jalexander@muskegonchronicle.com

Mark VerHulst was about as down on his luck as a person could be when he limped into Hackley Hospital's emergency room six months ago, his body gripped by what one doctor described as "exquisite pain."

The unemployed 23-year-old Muskegon man, who was working sporadically and homeless at the time, went to the hospital three days after a pelvic injury ripped a hole in his bowel. Doctors performed emergency surgery that saved VerHulst's life even though he had no money or health insurance to pay for the $27,000 procedure, according to medical records he provided to The Chronicle.

What has happened since doctors performed the colostomy -- which left VerHulst with a plastic bag attached to his abdomen that captures and holds all of his fecal waste -- could be described as an American health-care nightmare. VerHulst said he has largely recovered from his bowel injury. Doctors could remove the colostomy bag and restore his bowels, and life, to normal. But the surgeon who performed the original procedure won't remove the bag and reconnect VerHulst's bowels until he makes a $2,492 down payment on the followup procedure. VerHulst still owes the surgeon, Dr. Veronica Petty of Muskegon Surgical Associates, $4,608 from the first procedure, records show.

"At minimum wage, it's going to take me years to save up enough money to get this done," VerHulst said. "I just want to get this bag off my stomach; it's screwing with my head more than anything."

VerHulst said the bag makes him self-conscious and reluctant to spend too much time around friends, for fear they will smell it. He tried working with a roofing crew but said the physical labor made the bag leak. Dating, he said, is out of the question. "I'm worried that if I get a job and my bag messes up, I'll smell like crap," he said. "That wouldn't be good."

One health-care analyst said VerHulst's case illustrates the struggle by doctors, hospitals and insurance companies to remain afloat financially in an ailing health-care system that's drowning in debt. "We have a highly fragmented health-care system in this country, in terms of financing,' " said Leonard Fleck, a health-care expert and professor of philosophy and medical ethics at Michigan State University. "The consequence of that is when it comes to a case like this one, everyone points to someone else and says, 'It's not my responsibility.' "

Officials at Hackley Hospital, which billed VerHulst $22,000 for his December stay, said their staff doctors could not remove his colostomy bag because it requires a surgical specialist. The surgeon who is qualified to do the procedure won't remove the bag without payment in advance because the procedure is considered elective, much like a nose job or tummy tuck.

VerHulst has applied for Medicaid benefits, but said officials there told him he likely would be denied because his condition does not constitute a disability. The health insurance for low-income residents VerHulst obtained after his injury won't cover the cost of removing his colostomy bag. The reason: The surgery requires an overnight hospital stay, and his insurance, called Muskegon Care, only covers outpatient surgeries. "So I'm supposed to live with this bag for the rest of my life? That's cool," VerHulst said sarcastically.

Dennis Harris, the administrator at Petty's practice, Muskegon Surgical Associates, said federal law prohibited him from discussing VerHulst's case. But Harris said removing a colostomy bag on an otherwise healthy patient, someone like VerHulst, would be an elective procedure. The first procedure was performed, with no questions asked about VerHulst's ability to pay, because it was "medically necessary," Harris said. "If it's an elective procedure, the patient needs to find a way to pay for it," Harris said. "Otherwise, you continue down that path where you are providing elective procedures when you need to focus work on patients who have medically necessary procedures."

Harris said Muskegon Surgical Associates loses about $7 million annually on patients who are uninsured or underinsured. Doctors need to get paid for their work just like everyone else, he said. Vondie Woodbury, Muskegon Community Health Project executive director, often reminds people that everyone pays for health-care services provided to the uninsured and indigent. Woodbury and other experts have warned repeatedly that the nation's health-care costs will continue to escalate as the number of uninsured increases. Woodbury's mantra: "There is no such thing as free health care -- someone is paying for it."

VerHulst said he would get a job and try to pay for the surgery if he could. He said holding a job is difficult because his colostomy bag often leaks noxious fumes and, occasionally, fecal matter. "With a bag, you have no control over your bowels. Stuff comes out without warning," he said. The free health-care insurance VerHulst obtained after the accident only provides him with 10 colostomy bags per month. VerHulst said he often runs out of bags before the end of the month and has to use duct tape to keep the bags from leaking. "If I go to the emergency room, I can get more bags," VerHulst said.

But emergency rooms are one of the most expensive types of health care, according to industry experts. The fact that people like VerHulst end up in the ER for nonemergency treatment drives up health-care costs, insurance premiums and hurts hospitals' bottom lines, experts said. Federal law requires hospitals that receive federal funds to treat everyone, regardless of their ability to pay. Hackley Hospital last year spent $24 million providing free health care to the indigent and treating patients who later refused to pay or had insurance that only paid a portion of the bill, hospital spokeswoman Melissa Freye said.

Mercy General Health Partners in 2006 spent $12.6 million treating the indigent, uninsured and underinsured, spokeswoman Kelly Kurburski said. There are 18,000 uninsured people in Muskegon County and about 23,000 uninsured in Ottawa County. Nationally, 47 million Americans lack health insurance and that figure is growing by 1.5 million people annually, according government data. The fact that nearly 15 percent of Americans lack health insurance is one reason this nation leads the world in per capita health expenditures but ranks 25th in health status among its citizens, Fleck said.

He said it would be cheaper and more effective for the government to create a system of universal health care that provided care for all. Because VerHulst's surgery is considered elective, Fleck said Hackley Hospital and Petty have no legal obligation to remove the colostomy bag and make him whole again. "Do they have a moral obligation to do the surgery? That gets tricky," Fleck said. "I would argue that every physician has a moral obligation to provide some level of charity care," Fleck said. "However, physicians that get a reputation for providing charity care can get overwhelmed by charity care requests and could end up losing their practices because they're losing so much money."

Jeff Fortenbacher, executive director of Access Health, which administers the health insurance VerHulst now has, called the Muskegon man's situation unfortunate. Fortenbacher said Access Health may be able to help VerHulst get the surgery he needs. "It doesn't make sense to have somebody who is able-bodied and could be productive again hanging out there with a medical condition that doesn't allow him to move forward with his life," Fortenbacher said.