A test of dignity

Bent over and barely able to walk, Dale Gowan turned to Deaconess Medical Center’s emergency room for relief from the pain shooting down from his lower back and into his legs.

“We’re not in the pain management business,” Dale said the ER doctor told him before writing a prescription.

With his long hair and thin frame, Dale’s appearance apparently fit the profile of a drug user looking for a fix. At least, that’s the way Dale believes the doctor treated him – not as a man with a chronic back injury in need of attention.

A spokeswoman for Deaconess denies this was the case, which makes it the word of a health care professional against that of someone on Medicaid. But it would not be the first time Dale, 38, who came to Spokane in search of work with his wife, Rebecca, and their three children, has suffered the indignity of poverty. The family lived in an old school bus before entering a homeless shelter in January.

In March, soon after moving into the Salvation Army’s reduced-rent transitional housing apartments, Dale lost his job as a drywall hanger. His employer had read about Dale’s back problems in The Spokesman-Review.

More than 20 years of drywalling have damaged the vertebrae in Dale’s back, making it dangerous for him to continue the only work he knows.

In health care matters, the United States is still pretty much a country where you get what you pay for. By that standard, the Gowans are fortunate to have the care they are receiving at the Community Health Association of Spokane’s Maple Clinic.

CHAS, a nonprofit system of federally qualified community clinics, provides medical and dental care to patients regardless of insurance status. In 2003, the clinics treated more than 24,000 people, 18 percent of whom were homeless.

Nearly five months after his first visit to the Maple Clinic, Dale, who was diagnosed a year ago in Boise with a bulging vertebra, has yet to see a neurosurgeon or even get an MRI. Though primary care is available to the poor at clinics such as those run by CHAS, specialized care is still hard to come by for an estimated 45 million uninsured and an untold number of underinsured Americans.

Spokane is no exception.

“We haven’t as a community gone to the next step of getting people who have extreme needs that special attention,” said Becky Swanson, vice president for marketing and communications at Empire Health Services, which runs Deaconess.

John Driscoll, director of Project Access, a physician-led initiative to expand access to health care for low-income, uninsured residents of Spokane County, said Dale’s problem is far too common.

By law, hospitals have to treat patients, but medical specialists do not. Traditionally, a primary care doctor has to “lean on his buddies” in specialized care to have them see a low-income patient, Driscoll said.

This is largely because of low reimbursements under Medicaid.

Under Project Access, 600 Spokane County medical specialists have agreed to see a number of charity-care patients each year, perhaps 10 to 20, depending on what the doctor’s office can afford. Hospitals, too, have agreed to donate in-patient and out-patient services, Driscoll said. Funding for pharmaceuticals comes from Spokane County and its city governments.

Project Access patients must live in Spokane County and have incomes at or below the federal poverty level, currently $36,200 for a family of four, and they must have no other insurance.

“For the most part, we try to take people who can’t get Medicaid or anything else,” Driscoll said. “It is a complicated delivery system, there is no doubt. Even if you have Medicaid, there are all sorts of access problems.”

In cases like Dale’s, Driscoll said, “neurosurgeons often put up obstacles” until a patient has exhausted other remedies, such as steroid treatment.

“Primary care doctors really have to step up to the plate and advocate for a patient,” he said.

In the meantime, Dale believes he may have ruptured or otherwise further damaged his bulging vertebra during an accident while he was still working. He now walks with a limp he did not have when he arrived in Spokane.

His pain became so intense on April 25 that he had to visit the Deaconess Express Care emergency room, where he was treated by Dr. Dan Teng. According to Dale, Teng suggested he was there only for drugs, even though tests administered by Teng showed Dale had little or no response to reflex tests and had little strength in his legs.

When Dale said he was told by the CHAS clinic to go to the emergency room, he said Teng responded, “Don’t you think they’re dumping on us?”

Empire Health’s Swanson denied Dale was treated this way. Teng was merely stating that Dale’s problem was not something that could be treated in the emergency room. Though drug-seeking patients are a problem for emergency departments nationally, Swanson said, Deaconess’ records do not support the allegation that Dale was profiled.

Teng declined to respond to the newspaper’s request for comment. Swanson said it was hospital policy to handle media inquiries through its public information office. She said emergency room doctors see so many patients it would be difficult for them to remember such an incident.

“The physician may or may not have said, ‘We are not in the pain management business,’ ” Swanson said. “My question would be, what was his tone of voice? When a patient is in a lot of pain, even (something) said in a very nice way, it can be interpreted very poorly.”

Dale said he was given a prescription for painkillers and discouraged from coming back.

“I’m sorry the gentleman felt that way,” Swanson said. “In a perfect world, we are all treated with dignity and respect.”