His heart didn´t sound good. There was a murmur. And the carotid artery, which supplies blood to the brain, didn´t seem to be functioning well. The doctor ordered further tests.
So John Frey, who had been suffering from dizziness and headaches and now feared he might have a heart attack or stroke, went to the North Broward Medical Center one morning last week for an echocardiogram, an ultrasound, and an electrocardiogram.
Once there, a pleasant hospital attendant named Annette Perez briefed him on what he needed to do.
¨The three tests cost $1,639,¨ Perez told him at the registration desk. ¨You´re going to have to pay that today.¨
That was a problem. The 55-year-old Frey had lost everything -- his family, his business, his country club membership, almost his mind -- during a vodka- and cocaine-fueled downward spiral that began in his 40s. Four years sober, he´d come to Florida from Delaware last year for its first-rate Alcoholics Anonymous program and religiously attended two meetings a day.
Although his new state was a dream in terms of recovery, it was a nightmare when it came to health care. Suffering from depression, diabetes, and high blood pressure, he had no insurance and no money to pay his own way. He´d gone without insulin, wracked up almost $6,000 in hospital bills, and now he was being told he had to come up with money he didn´t have to see if he needed heart surgery.
¨If I can´t pay, what happens to me?¨ he asked Perez.
¨You can go to the emergency room,¨ she answered.
¨So I need to have a heart attack or a stroke before I can get help?¨
Perez didn´t have an answer for that, but he was right: In lieu of the money, he needed a medical emergency to get the care he needed.
¨We are not refusing you service,¨ Perez said.
¨You are definitely refusing me service if I don´t pay up front,¨ Frey returned.
Again, he was right.
Frey´s descent into health-care hell is indicative not only of the huge problems with medical care in America but also what happens to countless indigent people in Broward County.
In this case, it could be more than just wrong it might be illegal.
In charge of helping people like Frey is the North Broward Hospital District, which runs four hospitals and receives more than $200 million a year in property taxes to treat the poor. To borrow the words of its own employee handbook, the district is ¨the county´s safety net, ensuring that those who need care receive it, regardless of their ability to pay.¨
In Frey´s case, though, he kept getting hospital bills he couldn´t pay. And when he finally learned about what the district calls the Star program, which provides discounted and free medical services to indigent patients, he was run through the bureaucratic ringer.
He says he´s been turned away from the district office at the Seventh Avenue Clinic twice for not having the proper paperwork, which includes a notarized letter from his landlord, tax returns, utility bills, and a host of other documents.
¨I couldn´t get a letter, and I don´t have any tax returns,¨ explains Frey, who lived in a boarding house at the time. ¨I didn´t know what I needed to do, and nobody told me. Then, when I found out what to do, they turned me away because I didn´t have all the papers they wanted.¨
When Legal Aid Services attorney Sharon Bourassa, who has represented numerous district patients in the past, heard about Frey´s travails, she said she had seen dozens of similar cases, deeming it ¨unconscionable.¨ She says the district should have helped Frey get into the program the first time he stepped inside a clinic and said he couldn´t afford to pay.
By not doing so, she says, the district didn´t follow the law.
¨If a patient can´t show they are indigent, then under the law, the district must verify it,¨ Bourassa says. ¨You can´t ask patients to do something that is impossible for them to do. They should be inquiring up-front about his income and not asking him to go back and bring proof in on finances. These are emergency situations. The man shouldn´t be turned away or have to pay costs.¨
District spokeswoman Sara Howley agrees that it is incumbent upon NBHD to verify patients´ indigent status, but she says there are limits.
¨There´s no question we have wanted to help this gentleman, but he needs to provide us some information so we can help him,¨ Howley says. ¨We had a caseworker who tried to get him qualified. We had 52,000 people enrolled in the program last year, so we are helping people.¨
Maybe so, but Frey´s odyssey through the system seems to point to huge holes in that safety net that health-care advocates have been complaining about for years.
A big fellow with a bald dome and friendly demeanor, Frey had health care in Delaware and assumed it would transfer to Florida when he moved to Pompano Beach. He was wrong. With only $600 a month coming from a small trust fund from his mother´s estate to pay rent and keep him off the streets, he was able to get food stamps so he wouldn´t go hungry but had no luck when it came to health care. And it nearly cost him his life.
When Frey, who had been a general contractor in Wilmington, tries to explain how his life fell to such depths, he laughs. ¨You wouldn´t believe it if I told you,¨ he says. ¨Nobody believes it.¨
Upon prodding, he opens up. Frey´s father was a war hero and one of the best golfers ever to come out of Canton, Ohio, once qualifying for the U.S. Open. His grandfather, V.V. Frey, was also a sensational golfer, prompting the Canton Repository newspaper to once dub the clan ¨the teerific golfing Freys.¨
John Frey was touched with superior golf skills himself, but his World War II veteran father didn´t share any tips with him. In a sign of things to come, the former Army lieutenant, scarred from two years in a German prison camp, fell into alcoholism and left his mother when Frey was just six months old.
His mother, Ruth, went on to marry a very wealthy man in Delaware named John M. Clark, who was a vice president at the DuPont Corp. and owner of a large equipment company. The young Frey led a privileged life, attending the exclusive Blue Ridge School in Virginia. Frey´s relationship with his stepdad was strained, but with the help of his connections, he built a successful business in Wilmington as a general contractor.
¨I was a member of the Wilmington Country Club and the Chamber of Commerce and everything else,¨ he says. ¨I had everything you could want.¨
He married and had two daughters, but that marriage eventually went cold. Then he wed again and had a son. Frey says his business started deteriorating in the mid-1990s, but he kept putting on a good face. In 1996, at the age of 44, he was crowned putting champion and holiday tournament winner at the country club -- and he still has the newsletter to prove it.
Soon, though, both he and his business hit rock bottom. It started with too much booze, then powder cocaine, then crack. ¨The crack finished me off,¨ he says. ¨After that first hit, I was off to the races.¨
His second marriage crumbled and his life went haywire until he wound up in prison for almost two years for violating probation on a theft charge that came while he was in the throes of addiction. While incarcerated, his mother became ill and died. Frey says he´ll never get over the fact that he wasn´t allowed to go to her funeral.
When he got out, he went through rehab and decided to come to Florida because of its reputation for excellent recovery programs. He says he´s been clean for four years, speaks with his now-grown daughters as often as possible, and wants to build a relationship with his son, John Jr., who is now 14.
But even as he stayed clean, his other health problems especially the diabetes kept him down. With no insurance or aid, he gave up hope of getting the psychotropic meds and high blood pressure pills, but he knew he needed the insulin.
He could get prescriptions from the NBHD-run clinics but not drugs, and he couldn´t afford to fill a prescription. So he went without insulin, a ludicrously dangerous thing to do. Predictably, he fell ill and went to the district-run Imperial Point Medical Center emergency room in January, fearing he would fall into a diabetic coma.
There, he was treated and finally given some life-saving insulin.
Then he was hit with a $5,490 hospital bill he couldn´t pay.
Shortly after that, he met the woman he credits with saving his life, his ¨Florence Nightingale,¨ nurse Susan Volkmer. She befriended him and began helping him with his health care. The first thing she did was test his blood sugar level with a machine she had in her home.
¨It was so high there wasn´t a reading, which means it was above 500,¨ Volkmer recounts. ¨It said High, High, High.´ It was off the rocket. Diabetes isn´t something to play with.¨
She bought him insulin, with some of the costs reimbursed by the trust fund, which is controlled by Frey´s estranged uncle. She also found out about the Star program and helped get him an appointment with district workers in February.
Because he lacked the paperwork, he was turned away.
He went back in March. Same story.
He went back May 29. Same story.
¨John ran into bad luck,¨ Volkmer says. ¨He´s trying to get his life back together, and it seems the more he tries, the farther he gets set back. It´s the health system. Somewhere along the way, it got messed up. But he´s a good person, and he deserves good health care.¨
Because of Volkmer, Frey got just that last week. She put the cost of the heart tests at the North Broward Medical Center on her credit card. She hopes the trust fund will reimburse her, but there´s no guarantee.
Frey, who now lives with Volkmer in her condo, has another appointment with representatives of the Star program on June 15, where he´s hoping to finally get the help from the district he needs.
Waiting out in the lobby to get the tests that were already paid for, Frey talked about his life. ¨I´m cursed,¨ he surmised with a hapless smile.
¨You´re not cursed,¨ Volkmer told him. ¨You´re a lucky man, remember?¨
At that moment, it almost sounded true.
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