Clark County commissioners agreed Tuesday to cut a dozen programs and services at University Medical Center to offset the loss of $8 million in Medicaid funds.
In doing so, they offered few assurances for those concerned about where hundreds, and possibly thousands, of the county's poorest patients would go for cancer treatment, kidney dialysis and prenatal care.
Marilyn Johnson, who has been a nursing assistant for 11 years at UMC, said that because the hospital is no longer taking new oncology patients on an outpatient basis, patients are now being told, "I'm sorry."
"I'm sorry is not good enough,'' Johnson said after the meeting.
"We have bailout programs for people losing their homes. We have bailouts for people losing their cars. But what kind of bailout program do we have for people losing their lives? People are going to lose their lives because of these cuts,'' Johnson said.
She went to Tuesday's meeting expecting answers about where oncology patients would be directed, only to leave upset at the lack of information.
Nancy Whitman with the Nevada Health Care Reform Project, a group that aims to ensure all Nevadans have access to quality health care, asked similar questions but got no answers. She too left Tuesday's meeting disappointed and frustrated.
Many patients won't have anywhere to turn because they're uninsured and it's uncertain which Southern Nevadan health care providers take them, Whitman said.
Clark County commissioners "should have asked how these cuts are going to impact other health care providers. What the impact these cuts are going to have on people who can't find other services? And they should have asked what the long-term impact is going to be if these patients aren't able to get these services somewhere else in Southern Nevada,'' Whitman said. "What's going to happen is these individuals, especially oncology patients, are going to seek care in emergency rooms, and someone is going to have to pay for end-of-life treatment. In the end, we are going to end up paying.''
Some of the programs UMC is cutting, such as prenatal services in its Women's Center, are offered at other facilities, Whitman said. However, those health care providers don't have the capacity to take on more patients.
As an example, Whitman said one solution would be for UMC to fold its prenatal care program into the University of Nevada School of Medicine and Nevada Health Centers' programs. But Nevada Health Centers' waiting list for prenatal services is four months.
"If you're past your first trimester, you're considered a high-risk pregnancy and they won't take you. Are we now going to have more high-risk births because of this? That's just going to drive the costs up even further. Some of the things UMC is cutting will have an impact on other providers financially as well.''
Earlier this year, state health officials announced 5 percent across-the-board cuts in Medicaid reimbursements for inpatient hospital services. Hospital officials say some services are being hit harder. For example, UMC, like other hospitals, faces a 24 percent reduction in Medicaid reimbursements for Level III neonatal intensive care unit services, a department that treats preemies and newborns with medical complications.
Those cuts were prompted by the state's budget deficit.
Nevada Medicaid provides health care coverage to low-income Nevadans who qualify for services based on federal and state law. Eligibility is based on financial need.
Select services to end Dec. 31 include the high-risk obstetrical unit and antepartum testing, the outpatient mammography center and prenatal services at the hospital's Women's Center. In 90 days, outpatient coumadin therapy and the outpatient kidney dialysis service will end. The post-emergency hand clinic will end Dec. 19.
Though commissioners agreed with UMC administrators on the cuts, they weren't happy about the impact.
Commissioner Lawrence Weekly said he recently spoke to a 28-year-old woman who has breast cancer but has no health insurance.
"It bothered me to the core to know there's no place for this lady to go,'' he told Kathy Silver, UMC's chief executive officer after her presentation. "Who's going to step up? ... This is a crisis. Where will poor people go? Are we saying we'll just sit back and watch this 28-year-old woman die?''
Silver didn't answer Weekly but hinted that the cuts might be just the beginning. She said Medicaid is expected to announce more cuts in July.
"We'll probably be back,'' she said.
Representatives of some Southern Nevada for-profit hospitals, though not entirely sure about the impacts of UMC's cuts just yet, said the state's Medicaid crisis is only shifting the problem from one hospital to the next.
Dan Davidson, a spokesman for Sunrise Hospital and Medical Center and Children's Hospital, said because of the Medicaid cuts the two hospitals are losing $2.5 million in revenue.
With UMC cutting services, Sunrise could end up with the added burden of taking on more uninsured patients. In 2007, Sunrise provided more than $88 million in uncompensated care, Davidson said.
"We could be looking at cutting services as well,'' he said.
Some local organizations, such as Susan G. Komen for the Cure Southern Nevada, are calling on lawmakers to act quickly with respect to UMC's oncology department.
In a Nov. 13 letter sent to public officials, Jackie Brown, executive director of the Komen Foundation, said an estimated 1,600 women will be diagnosed with breast cancer in Nevada this year. With Nevada's high rate of uninsured, unemployed and home foreclosures, the area will see an increase in needs for services, she said.
Brown said uninsured women are more likely than the insured to receive late-stage diagnosis of breast cancer.
During Tuesday's meeting, Commissioner Rory Reid asked the county's staff to call a meeting of the governor, legislative leaders, community stakeholders, non-profits and private hospitals to discuss the health care crisis in Nevada.
"I think people are more focused on outpatient cancer treatment because that is the easiest thing people understand,'' Reid said. "I think we do need to be concerned about the 28-year-old woman with cancer, but we also need to be concerned with the thousands of people UMC sees on a daily basis.''
Contact reporter Annette Wells at firstname.lastname@example.org or 702-383-0283.