State agency vows to help LV father get medical care for two daughters

CARSON CITY -- State government will locate a surgeon to operate on two daughters of an unemployed Las Vegas pharmacist who testified before lawmakers he cannot find physicians willing to treat them because state Medicaid benefits do not cover their costs.

"Absolutely we will help them," Chuck Duarte, administrator of the state Health Care Financing and Policy Division, said Thursday. "We will ensure the kids get medically necessary care."

During an appearance Monday before a pre-session legislative budget committee, pharmacist Sheik Ellias said he cannot find Southern Nevada doctors willing to operate on his daughters, both of whom use wheelchairs.

Pediatric orthopedic specialists in Southern Nevada refuse to see Hannah, 8, and Zaynah, 5, because payments from the state's Medicaid program will not cover their actual costs, Ellias said.

Ellias quit his pharmacist's job because his wife left him and his children needed around-the-clock care. His girls suffer from cerebral palsy and leukodystrophy -- a progressive degeneration of the white matter of the brain -- leaving them unable to stand and in dire need of surgery. He also has a son with kidney problems.

Duarte said if a child needs surgery and a willing pediatric surgeon cannot be found in Las Vegas to treat them at rates the state pays, then his agency will take the child and a parent at state expense to Northern Nevada or out of state where doctors will treat them at the Nevada Medicaid payment rates.

"Sometimes we get better rates out of state, even with the transportation costs," Duarte added.

But handling children in need of critical care on a case-by-case basis might not be an efficient way to spend Medicaid dollars, said Larry Matheis, executive director of the Nevada State Medical Association.

"In this economic climate, not a lot of pediatric surgeons and hospitals in this country have the flexibility to absorb Nevada's children who need health care,'' Matheis said.

While sympathetic to the decisions Duarte has had to make the past year or so, Matheis said the state has a responsibility to pay reasonable rates to physicians who treat Medicaid patients.

And Dr. David Stewart, a pediatric orthopedic surgeon with Children's Bone and Spine Surgery in Las Vegas, said some hospitals in other states are refusing to take children from Nevada because of the reimbursement rates.

"This is not a viable long-term solution for the care of Nevada's children,'' said Stewart, who plans to fly to Carson City to testify before the Legislature. "It costs more to transfer children out of state."

Medicaid is the $2.8 billion state-federal program that provides medical care for the poor, disabled and elderly.

Under Gov. Jim Gibbons' two-year budget plan, the rate the state pays doctors and hospitals would be cut by 5 percent.

Duarte said that the state has only a handful of pediatric orthopedic surgeons, the kind of doctors who could treat Ellias' daughters, and they have been balking at treating children at state Medicaid rates.

He added that the rates they receive are 40 percent less than what they were paid as recently as September. They are being paid at levels set in 2002.

Two years ago, the Legislature and governor approved 70 percent increases in payments, but that benefit never was implemented because of the onset of the recession and cuts that had to be made.

Duarte said that in a recent survey, his office found 93 percent of physicians would continue to treat Medicaid patients.

During a Tuesday appearance in Reno, state Budget Director Andrew Clinger said that Nevada probably will receive $420 million in additional federal Medicaid matching funds as part of the economic stimulus plan in Congress. The Gibbons administration, when it prepared the budget, had an estimate of $108 million.

But Clinger said he did not know whether the additional money will be given to doctors. If the state receives it, he said, Gibbons and legislators might back out state funds now going to the Medicaid program and use them to fill other shortfalls.

Ellias said Wednesday he was unaware the state could send children out of state for care if it were unavailable in Nevada.

"No one has contacted me about this,'' he said. "How do they save money this way? It seems very expensive."

Duarte suggested Ellias talk with his staff at the state Health Care Financing and Policy office in Las Vegas about finding a doctor willing to treat his daughters.

Sending patients out of state is not uncommon, Duarte said, particularly in rural Nevada where few doctors practice.

When a doctor will not take state rates, the doctor typically refers patients to physicians in other states who will, Duarte said.

"It is a routine practice," he said.

Contact Review-Journal Capital Bureau Chief Ed Vogel at evogel@reviewjournal.com or 775-687-3901. Contact Review-Journal reporter Annette Wells at awells@reviewjournal.com or 702-383-0283.