Unemployed, uninsured in need of care

Kevin Jarina was uninsured and unemployed, having been laid off from a series of construction jobs, when one morning last March he was hit with abdominal pain so severe it doubled him over.

The 44-year-old asked his buddy, with whom he was sharing a cheap weekly rental in Carson City, to get him to the hospital, quick.

Jarina wound up in the emergency room at Carson Tahoe Regional Medical Center, where he was told he would need emergency surgery to remove part of his colon because of diverticulitis, which happens when pouches form in the wall of the colon and get inflamed.

That began a nearly yearlong medical nightmare that left Jarina homeless, bitter, and, after hopping a bus to Las Vegas in search of help, finally grateful.

Stories like Jarina's happen more often than anyone would like to admit and show "the huge gaps in health coverage in our state," said Assemblywoman Sheila Leslie, D-Reno, a member of the Legislative Committee on Health Care.

"In poor economic times like these, it becomes even more apparent that our (health care) system does not work. He (Jarina) puts a real face on a problem that could be any of ours tomorrow."

A Chicago native with blue-collar roots, Jarina had worked construction his entire adult life. It was all he knew.

He came to Nevada years ago because construction jobs were plentiful. But a shaky economy in recent years hit the construction industry, and Jarina, particularly hard.

He struggled to stay afloat financially. Until that day in March, he had managed to scrape by on his $156 weekly unemployment benefits and by picking up a day's work here and there.

Jarina's surgery was followed by a colostomy to give his bowel time to heal. The end of the bowel was passed through a temporary opening in his abdominal wall, and a colostomy bag was placed around the opening for drainage.

Jarina was told that the colostomy was temporary, that the two healthy ends of his bowel would be reconnected and the colostomy would be closed with another operation in a few months, he said.

He spent about two weeks in the hospital. His bill, which he still carries with him in a duffel bag, came to $57,521.

Jarina was still in a lot of pain when he left the hospital, and he was getting worried. He couldn't pay his medical bills, and his unemployment benefits were about to run out. He had difficulty paying for the colostomy bags and other medical supplies he needed.

Soon he could no longer afford his rent and began sleeping in his truck.

"Try changing a colostomy bag in a truck," he said. "There was no place to shower. It wasn't hygienic."

He had no luck finding employment, either.

"Nobody wants somebody with a colostomy bag for construction work," he said.

The colostomy bags Jarina wore sometimes leaked or burst. A fastidious man by nature, that mortified him.

"It's very embarrassing," he said. "You stink. You smell. What can you do? Crawl inside yourself?"

In the meantime, Jarina was denied both Medicaid and Medicare coverage, which are typically reserved for low-income families with children, the elderly, the very young and the disabled.

He visited nearly every charity and social service organization in Carson City for help, he said.

"It was all a dead end. I survived the best I could."

In June, Jarina went for a follow-up visit to the doctor who had performed his original surgery.

"Everything was clear," Jarina said.

It was time for another operation to close the colostomy. Jarina could work again, he thought; his life could get back to normal.

But his doctor refused to do the surgery, he said.

"He said I had to pay for it first, in cash," Jarina said. "If somebody cuts you open and alters your body, they should have to put you back together."

Jarina's Carson City surgeon, Richard Bessette, declined to comment through one of his nurses, citing privacy laws.

Jarina went back to his life, such as it was, and became deeply depressed.

"I couldn't find work. I couldn't make the payments on my truck," he said.

So in September, Jarina gave up the truck. He no longer had any regular place to sleep.

"I'd walk the streets at night and sleep in the park during the day," he said.

Also in September, Jarina got an infection and had to return to the emergency room. While there, he was told by hospital staff that the colostomy closure he had expected was an "elective" surgery, and the hospital could do nothing if his original doctor refused to perform the surgery.

Jarina spent five days in the hospital. This time, his bill was $15,564.

Diane Rush, a spokeswoman for Carson Tahoe Regional Medical Center, said she couldn't discuss Jarina's case because of privacy laws.

But "we don't turn anyone away from emergency care," she said.

Rush said she couldn't say whether the hospital would have performed Jarina's surgery if it wasn't considered an emergency, because each case is different.

"I don't know the circumstances he (Jarina) was coming in with," she said.

She emphasized that the hospital does "millions of dollars of charitable care every year."

The months wore on for Jarina, and it started getting cold.

"I got so fed up, having to walk everywhere, always running out of colostomy bags."

Around Thanksgiving, Jarina decided to catch a bus to Reno, but had no luck at the charities and social service organizations there, either. He didn't bother going to the hospital there.

"I figured I was out of luck," he said.

But Jarina had been reading the newspapers. He had read about University Medical Center in Las Vegas, about how the hospital provides a good deal of medical care to indigent people. He started wondering if UMC might be willing to help him.

Jarina also had received an emergency extension of his unemployment benefits.

Figuring he had nothing to lose, in mid-December he used the money to buy a one-way bus ticket to Las Vegas. From the bus stop, he went straight to UMC.

There, "everything fell into place," he said. "They said, 'We'll take care of you.'"

The hospital ran tests, sent away to Carson City for Jarina's medical records and contacted Clark County Social Service, which gave him a medical card so he could get the medical care he needed, free of charge.

UMC scheduled Jarina's colostomy closure surgery for Jan. 28.

In the meantime, he stayed at a local shelter that put him at the front of the nightly line for beds because of his medical condition.

As for the surgery: "It came out great," Jarina said. "I just had to wait for my plumbing to work again. I about hugged my doctor."

He was released from the hospital Feb. 4. No more colostomy bags. He didn't receive a bill.

Social Service workers helped Jarina arrange for housing so he could recover from surgery someplace other than a homeless shelter.

He is staying at the Silver Spur Hotel on Las Vegas Boulevard South.

But Jarina should have been able to get the help he needed in Northern Nevada, Assemblywoman Leslie said.

"Your average person -- your average construction worker -- who falls upon hard times doesn't necessarily know where to get help," she said. "It's very difficult to understand the system from the outside. We see these kinds of inconsistencies every day. It's not what we want from a health care system."

UMC treats more Medicaid and medically indigent patients than any other hospital in Nevada.

In fiscal year 2007-08, the hospital provided $118 million in uncompensated care, officials said.

That figure does not include reimbursement funds the hospital received for uncompensated care from the state and Clark County.

Each month UMC refers about 80 indigent people, who don't qualify for other types of assistance, to Clark County Social Service, county officials said.

Of those, about 40 also need housing assistance.

Jarina said he feels better every day. He is planning to apply for financial aid to attend truck driving school. He hopes to find work more steady than construction.

He will never again take his health, or a roof over his head, for granted, he said.

"You get sick, and the next thing you know you're broke, indigent and homeless."

Las Vegas Review-Journal writer Annette Wells contributed to this report. Contact reporter Lynnette Curtis at lcurtis @reviewjournal.com or 702-383-0285.