UMC’s bottom line not whole story for Las Vegas doctor

It was about four months ago when the old man was found barely breathing on a sidewalk near downtown.

How long he had been there, lying on his back in 110-degree heat, no one knows.

What is known is that when he was brought to University Medical Center by ambulance, he had second-degree burns over much of his body -- and that administrators say keeping him alive has already cost about $3 million.

"He apparently passed out from drinking too much," Dr. Jay Coates said recently as he and a medical team walked through the UMC burn unit and discussed the cases of patients on the daily census. "We still don't know his age and his name for sure. We think he could be a homeless American Indian but we haven't been able to verify that."

Coates, 46, is a physician most Southern Nevadans know because of frequent media reports on his remarkable efforts in the UMC trauma unit.

In 2003 he saved magician Roy Horn's life after he was dragged offstage by a tiger at The Mirage. And last May he headed a team that saved the life of Andrew Linn, the Marine veteran who was in an auto accident that resulted in a 2-inch diameter metal fence pole being driven through his mouth and out his neck.

Linn is now in good health and back in school at Southern Utah University.

On this day, Coates is working as medical director of the burn unit, additional duties that he took on last summer.

Even though he has been involved in other cases at UMC when it became impossible to find out the identity of a patient, it still troubles him that anyone ends up all alone in his or her final days.

"Nobody deserves to end their life this way," he said, peering through a window of the hospital room where the old man sleeps. "I can't help but wonder what circuitous path in life led him to be here. What wrong turn did he make? It seems so foreign to us, that somebody doesn't have family or friends to claim them."

The man, believed to be in his 60s or 70s, has a form of dementia, Coates said.

Sometimes it appears he is lucid, but when hospital personnel try to check out what he has to say, they can't.

He is no longer strong enough to walk. Curled up in the fetal position on his bed, his legs seem just a tad thicker than the legs on a wooden dining room table.

He can't eat enough on his own to sustain life, so he is largely fed through a feeding tube.

Coates said many of the man's organs, including his liver, are in desperate shape. Medications are still routinely dispensed to keep him alive.

Nurses tenderly care for the old man, working to keep him from developing bedsores.

Because the man can't be identified, Coates said UMC has been unable to get funding streams from either Medicare or Medicaid for his care.

It is a scenario, Coates said, that plays out again and again at the taxpayer-supported hospital, which basically acts as Southern Nevada's safety net for acute care.

What has happened to the old man with burns, Coates has seen happen to unidentified victims of crime.

"There are times when we never find out who they are," Coates said. "Some don't get better and they die alone in the hospital after months here. I expect it will happen to this old man. It tears your heart out."

Though obviously troubled by the abject loneliness of some patients as they face what may well be their last days, Coates is proud that hospital staffers try to give these patients who have nothing and no one the best chance at life possible.

But he is frustrated that the hospital is basically criticized each year at budget time for doing so.

"When people are critical of UMC's bottom line, they need to remember that it costs a lot of money -- sometimes millions -- to keep people alive, and some of our patients don't have any way of paying," he said. "Is it worth it? That's the question we have to ask, and answer, as a community."

Paul Harasim is the medical reporter for the Las Vegas Review-Journal. His column appears Mondays. Harasim can be reached at pharasim@reviewjournal.com or 702-387-2908.