Lack of Healthcare Causes Death

Dr. Robin Eastman Abaya

Summer 2015   Southern Tier, New York State

Ms. B was a 56 year-old woman found dead at her apartment by her mother. The death was referred to the local county coroner because she had no physician and an autopsy was performed to determine the ‘cause of death’.

According to the county coroner, “people said Ms. B was an alcoholic.” Neighbors had seen her stumbling up the street on her way to the village convenience store the day before she was found. She would frequently stop along the road and the last time they saw her, she ‘barely made it back’. No one bothered to ask if she needed help because they assumed she was ‘drunk’.

Ms. B had worked as an aide in a local nursing home, but was recently ‘fired’ for her inability to continue doing the job – which the employer thought was due to ‘alcohol.’

She had no other source of income. She had no medical insurance and no access to regular medical care. Her elderly mother tried to help.

Post-mortem blood studies showed no evidence of elevated alcohol and no abuse of drugs. Her liver showed none of the changes of chronic alcohol use.

Her heart was huge and flabby. Her lungs and liver were congested. Her heart had a narrow, defective aortic valve, which made the heart work extra hard until it just ‘gave up.’ She died of congestive heart failure due to aortic stenosis. Her stumbling along the street and inability to do her work, as an aide at a nursing home, was due to a failing heart, not drunkenness.

The diagnosis of aortic stenosis and heart failure should have been simple…if she had seen a competent primary care physician and not been ‘written off’ as a ‘drunk.’

Treatment for aortic stenosis has advanced significantly with patients being brought back to almost normal lives. Ms. B never had that option. She never had the option of being declared ‘totally disabled due to heart failure’ and provided the dignity of some social services. She never knew why she stumbled and gasped as she attempted to go about her daily life. But she must have wondered just how she had become a ‘throw-away’ person.

The medical system, with all of its elegant advances and its legions of highly trained, motivated health workers, failed in the simple task of recognizing and providing relief for this woman’s suffering – because there were too many barriers for this sick woman to surmount. The diagnosis of a huge failing heart could have been made by any physician with a stethoscope.

In our glossy magazine ads for private hospitals, clinics and the newest pharmaceuticals we will never see a Ms B struggling and gasping as she walks home. Our television ads only show romantic images of smiling, caring actor-physicians holding hands with attractive and grateful actor-patients ‘saved’ by marketed ‘miracle’ drugs which earn millions of dollars of profits for the drug industry each year. Ms. B will never stumble into such an idyllic TV commercial scene with her swollen ankles and congested face.

If Ms. B had lived in Canada, or anywhere in Europe, or Japan, or Taiwan, or Korea or Cuba… she would have been diagnosed and treated – because they have widely available public health systems or public payment systems that would not let Ms. B fall between the cracks (too young for Medicare, too poor for insurance and too weak to fight for her rights). In Europe, she would have had a local clinic and health care team to diagnose her problem and provide her with some relief from her suffering. Virtually anywhere else in the industrialized world, she would have lived in societies that recognized her right to the dignity of basic quality health care.

What happened to Ms B is happening to tens of thousands of sick working Americans lacking access to a health care system. The lack of health insurance or access to care should be written as a contributing factor on many thousands of death certificates in the US every year.

Millions of other people in the rest of the industrialized world simply take health care for granted as their basic human right. Hardly anyone in Canada would view access to basic quality health care as a ‘luxury’ reserved only for the ‘deserving’ the way it is presented here.

The private, for-profit, commercial health insurance system of health care delivery has been a failure. Its huge, wasteful expense, profit orientation and chaotic administration have significantly contributed to our country’s economic decline. We pay twice as much per capita on health care as the most expensive system in Europe and yet we get thousands of tragic cases of Ms. B. Our health care statistics place us at the bottom among industrialized nations.

It is time to tear down these barriers to care and provide the public with a publicly funded, single-payer system as a basic human right.

 

 

 

 

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