Mar. 16--A month after being diagnosed with a relapse of ovarian cancer, Terry Turpin was hit with news nearly as bad.
Mervyns, her employer of 27 years, had filed bankruptcy and was closing. She was going to be out of a job. Even worse, the 47-year-old Oxnard woman was going to be without health insurance when her life depended on receiving treatment.
"It's scary not to have insurance when you're not in good health," she said of the first time in her adult life she's been without a job or insurance. "It's one of those things I took for granted."
The scariest part of her story is it's not just her story. Visits from uninsured cancer patients who come to the Ventura County-run oncology clinic because they can't afford care elsewhere rose 32 percent from 2007 to 2008.
County oncology doctors say the surge has grown even more over the past several months. They cite a two-week period when they encountered five new cancer patients facing the same nightmare.
They or their spouse had been laid off. They couldn't afford insurance. They couldn't pay for chemotherapy drugs that can cost $4,000 for one treatment. Their private doctors couldn't absorb the prices either and referred them to the county program because it's designed for patients who are poor or have little or no insurance.
"I'm glad I could come here," said Turpin, who praises the care she has received. "I didn't really know where I was going to go."
The problem reaches beyond Ventura County. Public hospitals throughout California not only are seeing a surge in uninsured patients with all kinds of healthcare needs, they're seeing more cancer patients who need chemotherapy or other treatment and have no way to pay for it.
"We think it's only going to grow," said Amy Weitz, spokeswoman for the California Association of Public Hospitals and Health Systems.
She and county healthcare administrators say public facilities are meeting needs and will continue to do so. Other people worry.
"I don't know how far that will go," said Dr. Carolyn Bruzdzinski of the American Cancer Society in California. "If we continue to rely on that happening, I think that is going to stress the system in a different way."
Not enough choices
Turpin lives with her 72-year-old mother and says her strength comes from faith and prayer. She was diagnosed with advanced cancer in 2004 and went through five months of chemotherapy.
In September, tests showed the disease had re-emerged. She started chemo again, wearing a blond wig to cover one of the side affects. On Dec. 28, her last day as home fashions supervisor at Mervyns in Ventura, she still needed a final session. She wasn't sure it would take place.
"I was a little worried about it," said Turpin, understated enough to refer to her cancer as a bump in the road. "I wanted to make sure."
She could have purchased insurance through a federal program but that would have cost $507 a month. She didn't have it.
She sent an insurance application to a private HMO and included details about her cancer. She never heard back.
"People hear cancer and they freeze and freak out," she said.
More hands tied
If patients pummeled by the recession have few options, private oncologists who want to treat them aren't much better off.
One dose of the chemotherapy drug, Taxotere, costs $1,200. It's often used in tandem with several other drugs including Herceptin, which costs $490.
Doctors who try to absorb those costs don't stay in business very long, said Dr. Hany Khalil, a Simi Valley oncologist. Many of the doctors also won't treat patients covered by Medi-Cal for the same reason.
"In the olden days, most of us were willing to take a hit on a few patients because we were doing OK," Khalil said, noting the recession has ended those days.
Turpin started seeing Dr. Ann Kelly of Oxnard after she was diagnosed five years ago. When she relapsed in September, Kelly delivered the news.
And when she lost her insurance, Kelly referred her to the county clinic.
"She was in need of treatment that cost thousands of dollars," said the doctor who, if not for the county clinic, would have scrambled to find a way to cover the costs of Turpin's final chemotherapy treatment. "She needed ongoing follow-up. I didn't think it was in her interest to be in a practice where we would have to patch things together."
No place to recline
The county oncology and hematology clinic sits at the back of the Ventura County Medical Center's campus in Ventura in what was once a juvenile detention center.
There are 15 reclining chairs in two rooms where people watch DVDs and read magazines as they receive chemotherapy drugs that make them nauseous, make their hair fall out and treat their cancers.
A half-year ago, some of the chairs were often empty. Not anymore.
"We're running out of chairs to treat people," said Dr. Evan Slater, the center's highly respected director.
The clinic is meeting the increased needs. But Slater joked some of the chemotherapy may be relocated to a patio until the county finishes building a facility that will house the cancer program and other clinics.
He's not joking when he blames the surge on the falling economy and the increase in people who don't have the insurance to pay for private healthcare.
The number of uninsured patients at the clinic increased from 1,248 visits in 2007 to 1,647 visits last year. In one day, the clinic received 14 referrals for patients who couldn't afford care elsewhere.
Their costs may be covered by Medi-Cal, other government funding or the county's own program for the uninsured called Access Coverage Enrollment. Some of the patients, including Turpin, pay for their care while the county tries to enroll them in a financial assistance program. But they pay at greatly reduced rates.
Their drug costs -- one of the most expensive aspects of cancer care -- are offset by programs that allow the county to buy drugs at reduced rates or acquire supplies for free from drug companies.
Turpin said she feels comfortable at the county clinic. Kelly, her former doctor, praises the program and the safety net it provides. County healthcare administrators note the clinic is part of a system that also can provide radiation, surgery and other treatment for patients.
The total number of visits from all patients at the clinic rose from 8,359 in 2007 to 9,933 in 2008. The county's cost for cancer drugs rose more than $2 million to about $4.8 million last year.
The increases come at a time when government budgets are being cut.
"I'm not sure the county is going to be able to cope with this," said Khalil, the Simi oncologist. "A lot of patients are going to be left without treatment."
County administrators say that won't happen. They talk about cost-saving strategies, maximizing resources and federal money that funds their program for the uninsured. They are adamant the safety net will hold.
"Their need is immediate and our commitment to treating them is 100 percent," said Dr. Bob Gonzalez, medical director for the county's health care agency.
Hope survives
County oncologists worry about trust. They face situations where people fighting for their lives and in the middle of treatment have to adapt to doctors who are strangers.
Because the patients can't pay, they often put off healthcare, sometimes coming to the clinic when there's no chance for a cure.
They come with the mindset of "don't you have a miracle for us?" Slater said. "It's kind of sad when you say no."
Turpin's story is different. She hit the safety net in time. After her final chemo session at the county clinic, tests showed no signs of cancer. Now she waits and prays.
"I feel good about it," she said. "I told the doctor, 'This is it.' I won't have to do chemotherapy again."
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