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Perspectives

Jonathan Ross, MD
Toledo, Ohio

I treat adults with multiple medical problems. Many of them are uninsured.

Last November, my patient, a man in his 30s, came to see me for the first time. He had swelling in his legs. A full-time employee at a fast-food chain, the swelling made it difficult for him to stay on his feet all day. On questioning, he also suffered from snoring and severe daytime drowsiness. These are serious symptoms suggestive of sleep apnea syndrome, a breathing disorder that affects 12 million Americans. He likely had heart failure due to oxygen deprivation from episodes of obstructed breathing during sleep. The struggle to breathe disturbs sleep. If left untreated, sleep apnea can also cause serious health problems such as heart disease.

I told him his symptoms were serious and scheduled him for a sleep study to confirm the diagnosis. I gave him diuretics to ease the swelling and nasal spray to clear his stuffiness. I urged him to schedule a follow up visit within the month to review his condition and discuss the results of the sleep study.

But like so many of my patients, he fell through the cracks and missed his next appointment. It was a busy morning and I hadn't inquired about the man's insurance status and just treated him. Looking back, I feel bad about that.

Two months later he returned. This time, an ankle injury prevented him from working. He needed a doctor's note to verify his condition and return to work.

During the visit, he admitted that his drowsiness and swelling were worse. He looked bad. I refilled the diuretics and urged him to enroll in our sleep study program, which would help diagnose the cause of his apnea and provide a device that would assist with breathing at night.

He was interested but resisted. When I inquired further, he reluctantly admitted that he lacked health insurance and couldn't afford treatment on his own. He had chosen to suffer with his serious condition once he found out the cost of treating it. The breathing device can cost as much as $3,000 a year and the sleep study could run another $2,000.

But I convinced him that his condition was dangerous, and, if left untreated, would cause serious heart failure. I determined that for him to get coverage, he must be declared totally disabled and lose his job.

He eventually accepted my diagnosis and let me take the necessary steps to help him get care. So I began filling out the reams of paperwork for disability benefits. I called a pulmonary specialist, who agreed to waive his $300 fee to assess my patient's condition so he could be enrolled in the sleep program quickly. I set up an appointment.

After weeks of waiting, my patient was finally going to get the care he needed for his treatable problem. But it was too late. The day of his pulmonary appointment, a nearby hospital called. My patient had been brought into the emergency room. He had died in his sleep from heart failure. I requested a post-mortem exam, which revealed no serious illness other than his severe sleep apnea.

Although I can second-guess how I handled this case, I know this man died unnecessarily because insurance and payment issues interfered. Sleep apnea is a serious but treatable condition. Because of his insurance status, appropriate care came too late for this young man.

As a physician, I am constantly frustrated by a health system that erects barriers for people like my patient, a hardworking man whose financial limitations prevented him from getting good care.

Author: Jonathan Ross, MD, is the medical director of St. Vincent Mercy Medical Centerís Outpatient Internal Medical Clinic in Toledo, Ohio.




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