Coverage may have saved patientIn the debate about a health-care overhaul, there are countless stories of families saddled with hospital bills and unemployed workers who have lost their insurance.
But the story of Eric De La Cruz, of Las Vegas, stands out as a striking example of both the best and the worst that the American health-care system has to offer -- extraordinary medical prowess that is too often out of reach for all but the luckiest and best insured.
In his early 20s, De La Cruz was told he had a disorder called severe dilated cardiomyopathy, in which the heart muscle becomes enlarged and weak. The symptoms include breathlessness, exhaustion and fluid buildup in the arms, legs and abdomen.
He was a student who had worked part time as a graphic designer and a disc jockey, but none of his employers offered health insurance. Once he got a diagnosis, his family says, he was unable to buy private insurance because he had a pre-existing condition.
He twice applied for Social Security disability benefits, which would have entitled him to health coverage under Medicare. The applications were denied. He did eventually qualify for Nevada's Medicaid program, which bases eligibility on financial need rather than age or disability.
As his condition got worse, it became clear he would need a heart transplant. In some states and the District of Columbia, the transplant would be covered by Medicaid -- but not in Nevada, where the program covers heart transplants only up to age 20.
Ben Kieckhefer, a spokesman for the Nevada Department of Health and Human Services, defended that policy. "All insurance plans decide what things they are going to cover and what things they are not going to cover," he said.
This spring, De La Cruz's sister, Veronica De La Cruz, a former anchor for CNN, began a two-pronged effort to save her brother. Her first hope was to win disability benefits so he could qualify for Medicare, which would cover a heart transplant. A hearing had been scheduled for spring 2010, far too late to save him. She appealed to state legislators to pressure a federal panel to expedite the disability hearing.
"How can a sick person navigate the system?" she said in an interview. "I am healthy and can barely do it on my own. The system is designed for people to get frustrated and give up."
Veronica De La Cruz also began contacting heart-transplant centers to determine whether she could pay for the operation with donated money. Because Nevada has no heart-transplant center, she contacted several medical centers in California and was told that without insurance, her brother would need to post a deposit of at least $150,000 to be evaluated and placed on a waiting list. The total cost for the transplant and subsequent hospital care, as well as anti-rejection drugs, would be nearly $1 million, payable in advance.
To exert public pressure and raise money, Veronica De La Cruz began sending out messages on Twitter, with daily tweets about her brother's health, his dog, Chance, and the red tape she was trying to cut. She gained a following of more than 6,300 people, whom she began calling Eric's Twitter Army.
The troops included Trent Reznor of the band Nine Inch Nails, which said it would award donors backstage passes and time with the band; the famous Tony Hawk auctioned autographed skateboards. Supporters bombarded Nevada legislators with calls, faxes and e-mail. The Medicare hearing was rescheduled, and by June, Eric De La Cruz had won his long-awaited coverage, opening the door to a heart-transplant center.
Elated, Veronica De La Cruz contacted UCLA Medical Center's heart-transplant program, but now the hospital insisted that her brother get a secondary insurance policy -- even though Reznor said that the band raised nearly $1 million in less than two weeks. A hospital spokeswoman declined to comment on the case, citing patient privacy, but said that the hospital "had been working with" the family.
Eventually, Veronica De La Cruz arranged for her brother to be seen by doctors at the University of Southern California Medical Center. There, he spent a week on the "high-priority transplant" list.
But his condition had deteriorated so much that he soon became too sick for the procedure. On July 4, Eric De La Cruz died, at age 31.
Veronica De La Cruz says a surgeon told her that he could have helped her brother, but he arrived "two years too late." If not for all the delays and denials, she says, her brother would be alive today.
http://www2.journalnow.com/content/2009/sep/01/coverage-may-have-saved-patient/