In the economic crisis, public hospitals are needed now more than ever. If you're down on your luck without insurance, the county hospital can be your last resort.
Recently thousands of letters went out across Las Vegas telling cancer patients that the only public hospital in the state was closing its outpatient clinic for chemotherapy.
It's the next thing in the recession - communities cutting back on services like schools or cops or public hospitals because tax revenues have fallen with the economy.
One of the charity patients who got that letter in Las Vegas is Helen Sharp, who didn't realize how a crash on Wall Street might threaten her life.
"I don't want to die. I shouldn't have to die. This is a county hospital. This is for people that, like me, many people have lost their insurance, have not any other resources. I mean I was a responsible person. I bought my house. I put money away. I raised my two children. And now I have nothing. You know my house isn’t worth anything. I have no money. And I said 'What do I do, but what do all these other people do after me?' 'And they said we don't know,'" Sharp told 60 Minutes correspondent Scott Pelley.
Sharp, 63, has been fighting lymphoma since July. She's not working because of her illness and has no insurance. Last year, she received charity care at the county hospital, University Medical Center. She was one of 2,000 patients who got the letter.
"Dear patient, we regret to inform you that the Nevada Cancer Institute will no longer provide contract oncology services at University Medical Center," Sharp read.
Since December 31, there has been no chemotherapy for new outpatients.
Asked what reading this letter meant to her, Sharp told Pelley, "A death sentence."
University Medical Center is the safety net for two million people; Las Vegas bets its life on it. UMC is a teaching hospital, the only fully equipped trauma center, the only burn unit, the only transplant unit, and the primary source of charity care in a city that has fallen on the hardest times it has ever seen.
"Obviously, our gaming and tourism is tanking. The construction industry has been decimated. And all of those things cause big, gaping holes in the state budget. The hardest-hit area for us was the Medicaid budget," Kathy Silver, the hospital's CEO, explained.
Silver had signed that letter patients received.
Literally overnight, UMC's budget was cut by $21 million. "And we were already scheduled or budgeted to lose $51 million. And so, when you layered on $21 million on top of that, that brought our loss, or anticipated loss, to $72 million," Silver told Pelley.
The $21 million was cut by the legislature when tax revenues went bust. Nevada is number one in foreclosures; unemployment is over 10 percent, double what it was last year and climbing.
Silver told 60 Minutes she had to defend her unique services like the trauma center, so she chose to sacrifice services that are duplicated at private hospitals, even though patients may not be able to afford them.
Asked what services she had closed, Silver said, "We no longer provide prenatal services. We closed the outpatient oncology program. We cancelled a contract for outpatient dialysis. We closed the dedicated high risk obstetrical unit that we had. And we stopped doing outpatient mammography."
60 Minutes was there in February when the women's cancer clinic closed.
"When the hospital first informed you that the outpatient oncology clinic was closing, what did you think?" Pelley asked Dr. Nick Spiritos, who treats ovarian and uterine cancers.
"How can you do this to cancer patients? They're dying. If we don't provide them care, their outcome is guaranteed. They're going to die," he replied.
Pelley spoke to several of those patients. Roy Scales, a laid off security guard with lung cancer, went to the hospital and got the news in person.
"I walked in, the lady looked down and said 'Well, I don't see anything down here for you.' Then she looked in the computer and she said, 'Oh, you were supposed to have an oncology today but it's been canceled. Our oncology department is closed,'" Scales remembered.
"They turned you away at the door," Pelley remarked.
"They turned me away at the door without telling me anything," Scales said.
Asked what he was thinking when he walked out of the hospital, Scales told Pelley, "I mean where am I going to find help? I mean, I'm messing with a disease that will kill you. And for every day that I don't get medical input, I mean, this advances on my body."
Cancer is advancing on Livia Ralphs, who was recently laid off from her job selling cosmetics.
"It goes from here to here," she explained, pointing out a bulge on the left side of her neck. "You probably see it sticking out."
"So, in terms of the cancerous growth in your neck, the doctors believe it's treatable. But you don't have a way to treat it?" Pelley asked.
"I have no funds. I have no insurance. Nothing," Ralphs replied.
Patients who got the letter, like Helen Sharp, were sent a list of private chemotherapy centers, which leaves them in essence begging for care.
"One drug is almost $50,000. One drug, Rituxen. Who can afford that? There's nobody that can afford that unless you’re a billionaire," she told Pelley.
Some of the patients 60 Minutes met are gravely ill. But all future patients are affected, including those with early, highly treatable cancers who would benefit the most.
"Well, I'm sad. Because I know that there is room to serve patients and yet, financially, we can't afford to," UMC's CEO Kathy Silver told Pelley, as she showed him her closed chemotherapy unit, which had treated 40 patients a day for 20 years.
"You have the facility…to save lives. You have people outside the hospital who need to have their lives saved. And you just can't put two and two together?" Pelley asked.
"The financial situation that we find ourselves in caused us to make some decisions that I think all of us, to a person would rather not have made," Silver said.
There are two medical assistance programs for the very poor, like the folks who line up at a Las Vegas building before dawn to apply for state services: there's Medicaid and Clark County medical assistance.
"So if you're poor enough, you're okay?" Pelley asked Silver.
"If you're poor enough you're fine because those patients are being taken care of," she replied.
"If you're rich enough you're obviously fine. So who is falling through the cracks here?" Pelley asked.
"The patients who don't qualify for a social services type of program," Silver said.
"What we're talking about here are people who are making $30,000, $40,000, $50,000 a year and have lost their jobs and therefore lost their insurance?" Pelley asked.
"That’s correct," Silver replied.
"The middle class," Pelley remarked.
"That's correct," Silver said.
Yolanda Coleman is 45 years old and a single mother. Her breast cancer has entered her bones. 60 Minutes found her at home, bedridden, with a broken hip. It's hard to know how much she could benefit from chemo. But when Pelley met her, she was receiving almost no care at all.
"A few months ago there wouldn't have been any question about whether you could have your next round of chemotherapy. UMC would have been available and you could've gone there," Pelley said.
"Yes," Coleman replied.
Asked what it means to her that this program is gone, Coleman told Pelley, "It's devastating. It's devastating."
She worked her whole life as a maid in hotels and as a truck driver, which earned her better money to support her 9-year-old son and 16-year-old daughter.
"As we sit here at this moment you don't know whether there will be another round of chemo for you?" Pelley asked.
"I don't know. It's just so uncertain right now I really don't know. I just trying to live it day by day and trying to keep my spirits up and you know trying to get well so I can take of the two…I got in there, I gotta take care of them," she replied.
She had three rounds of chemotherapy under her insurance plan. Then, she became too sick to work, and lost her insurance - exactly the situation UMC used to take care of.
"You know Yolanda, I think most people watching this interview think to themselves that if they get cancer and they don't have health insurance that somebody’s going to take care of them," Pelley remarked.
"No, no, there's nobody to take care of you," she said.
When Pelley asked Kathy Silver if what is happening in her Las Vegas hospital is unique or whether this kind of thing is happening all over the country, she told Pelley, "I think this is happening to some degree, probably, every public hospital across the country. I think it's happening to us to a greater degree because we are we're sort of the epicenter of what's happening. We're a demonstration project, if you would, of all the things that can go wrong at once."
Nick Spiritos, the doctor from the closed women's clinic, has not been able to leave his patients behind. "We've taken care of these ladies for years. They've been our family. You're not gonna push them out in hard times," he told Pelley.
He took a storeroom in his private office and spent $100,000 turning it into a chemo clinic for ovarian and uterine cancers.
"And you told them they can come here to your clinic and receive free medical care?" Pelley asked.
"Correct," Spiritos replied. "We've asked those who can pay, pay. If they can pay $5 a month, they pay $5 a month. If they can pay $20 a month. We're asking them to do what they can. And those who can do nothing, that's our job to take care of them."
Spiritos expects 10 percent of his patients won't be able to pay, so he and his partners will cover them. They've put collection boxes out at convenient stores around town. Other private clinics are also providing free care. And charities, including the Susan G. Komen Foundation, are stretching to help the desperate.
But these are emergency measures.
After a month of uncertainty, Helen Sharp was treated at UMC. With the outpatient clinic closed, the hospital admitted her as an inpatient. It says it made an exception because her heart disease and diabetes are life threatening complications.
But Livia Ralphs is still searching for care. "I'm going to die if I don't get treated. That's the bottom line here."
Yolanda Coleman remains untreated. After 60 Minutes' visit, a medical supply company took away her hospital-style bed and her wheelchair.
"You never know what God has for you down the road," she told Pelley. "But, I know he has more for me than just to leave my children because I can't have medical insurance."
Roy Scales has been calling the private doctors from the list University Medical Center sent with its letter. He has been searching for someone who will accept payment from the county's medical assistance for the poor program, which he calls insurance. It has been five months since he was diagnosed.
He told Pelley he called at least 25 doctors and oncology practices trying to find care.
Asked what they told him, Scales said, "'What about that insurance? Well, we don't accept that insurance.'"
"What are you going to do if you can't find a doctor to take care of you?" Pelley asked.
"Die peacefully," Scales said.
Roy Scales is now in hospice after finally consulting with a doctor. Yolanda Coleman, the bedridden mother of two, had her insurance reinstated after 60 Minutes called the insurance company to ask why she had been dropped.
The Nevada state legislature is now considering a proposal to cut millions of dollars more from the budget of University Medical Center.
Bob DeMarco is a citizen journalist, blogger, and Caregiver. In addition to being an experienced writer he taught at the University of Georgia , was an Associate Director and Limited Partner at Bear Stearns, the CEO of IP Group, and a mentor. Bob currently resides in Delray Beach, FL where he cares for his mother, Dorothy, who suffers from Alzheimer's disease. He has written more than 500 articles with more than 11,000 links to his work on the Internet. His content has been syndicated on Reuters, the Wall Street Journal, Fox News, Pluck, Blog Critics, and a growing list of newspaper websites. Bob is actively seeking syndication and writing assignments.