Fortunate moment, but peril persists

It continues to happen.

Yes, even with the Affordable Care Act, Medicaid, Medicare, Volunteers in Medicine of Southern Nevada and the Emergency Medical Treatment and Active Labor Act, there are people — some of whom may well be your neighbors — who end up in desperate need of medical treatment.

Rachel Palmer is a case in point.

About a month ago, the 31-year-old contract sportswriter for an Internet site moved here from Georgia to live with her mother, Judy Palmer.

It didn’t take long for the mother, a colon cancer survivor, to notice a growth on her daughter’s leg that looked strange.

“Given she didn’t have insurance, I wasn’t really sure about what to do, who to see,” said Judy Palmer, who works in an accounting department for a local firm.

Though her daughter didn’t have insurance, Judy Palmer got her an appointment with Dr. Kevin Petersen, who had removed a cancerous tumor from the mother four years ago and was still providing her aftercare.

“Her mother brought her in to see me about three weeks ago for a mole on her right ankle,” Petersen said. “When I saw it my heart sank. I was about 90 percent sure it was a melanoma and probably advanced. I instructed her to apply for the Affordable Care Act and do whatever it took to get insurance. I knew she would need surgery and possibly several operations and chemotherapy.”

Though it was past the open enrollment period in Nevada for the government- sponsored program, there was a good chance Rachel Palmer would still be able to get insurance under the act. Her move, which is considered “a qualifying event,” means there can be an exception to the normal protocol.

She visited Nevada Health Link’s website and applied. A couple of days later, a staffer phoned her to give her a phone number to call to learn how she could get insurance.

She and her mother called the number at least 20 times with no success, generally getting a busy signal. When they did get through, they only could leave voice mails.

“I said I had melanoma,” Rachel Palmer said, “but no one called me back.”

I called the number given the Palmers and also got busy signals. When I called Mary Woods, a spokeswoman for the Nevada Department of Health and Human Services, she acknowledged that Nevada Health Link, which has suffered many well-publicized problems, was having phone “issues” but said they should be cleared up by the end of the month.

“Rachel and her mother tried for a week to get insurance through ACA,” Petersen said. “I could not let her wait.”

Rachel Palmer was fortunate — incredibly fortunate that her mother made her an appointment with Petersen.

It turned out that the physician, who began Helping Hands Surgical Care, a nonprofit organization that has another half-dozen doctors performing surgeries at no cost to the uninsured, and the group had enough money left from fundraising in its coffers to cover facility and lab costs for an unexpected procedure.

As positive as that was, even more positive were the results from the operation Petersen performed. It appears, he said, that removal of the melanoma through a “wide excision” rid Palmer of her cancer and no further treatment is needed.

That good news, however, is tempered by Petersen.

“I consider this to be a nightmare scenario,” he said. “Other patients wouldn’t be so lucky to have gone to someone who just happened to have a connection to a nonprofit organization. If her treatment was delayed … her cancer would have progressed to an incurable stage and she would have died within another year. How can this happen in America?”

It repeatedly happens, said Dr. Dale Carrison, head of emergency and chief of staff at University Medical Center, because people, for one reason or another, don’t know the best way to access the health care system.

Just as Elizabeth Trujillo didn’t last year. She was out of work and without insurance when she discovered small lumps in one of her breasts. Her contacts with people convinced her she had to have insurance before she could get help. By the time she got a job and her insurance kicked in, she was stage 4. The mother of three is now inoperable and praying for a miracle.

“Even though it wasn’t technically an emergency, if she had come to the UMC emergency room she would have been referred to the surgical clinic and she would have gotten treatment,” Carrison said, pointing out hospitals that help the uninsured have an incentive to defray costs by finding an appropriate assistance program for a patient.

The American Cancer Society also says it will help people find the resources for treatment.

“Too often, we see people in the emergency room when it’s too late and then it costs even more,” Carrison said.

Carrison said it is also too often assumed that all people know how to use a computer in dealing with the health care system, and that people had one to sign up for the Affordable Care Act.

“One of the biggest problems we have in this community is helping people navigate the system,” Carrison said.

Dr. Mitchell Forman, president of the Nevada State Medical Association, said the difficulty with navigating the health care system is not limited to Las Vegas. All across the country, he said, people have the same problem.

Theoretically, he noted, the Affordable Care Act was supposed to do much to remedy the problem. But problems with the program’s rollout, coupled with 25 states not opting into the program, have left millions without insurance.

“I promise I’ll get some of the best minds together and see if we can’t come up with a good way to help people navigate the system in Las Vegas,” he said. “We have many good programs to help people who need it. They just need to know how.”

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.