November 7, 2003
Question from Aledo, Illinois, USA:
My 22 year old nephew, who has type 1 diabetes, has no health insurance and is extremely ill. My parents have taken him to the doctors, and he is receiving very little help. He was taken again today and given pain medicine to help him deal with the pain and told the will see him again in about two weeks. When I spoke to my parents tonight they said they fear he may pass away before then. They say his face is sunken in, he is down to skin and bones, passes out, he has been to the hospital and doctors and been given pain pills to help him deal with it, I say it because we don't know what it is. He has not been able to get proper care without insurance and yet can't get insured. He has applied for disability but has not heard yet. I feel it's extremely sad when we will watch a twenty two year old kid die because he can't pay. There are all kinds of financial assistance out there if he had a gambling problem or drank too much. However, he has something he did not bring on himself. Do you have any ideas how we might get him the proper care soon?
I tend to feel the same way as you do. In my practice, I have many patients that have recently separated from their families. Although they are the head of their household, they have no way to obtain medical insurance. A great society takes care of its people. Our current healthcare system is not set up to ensure people who are not working don’t fall through the cracks.
Additional comments from Dr. David Schwartz:
While your nephew’s situation is heart-breaking, there are some things
you can do. Many communities have a “free-health clinic.” Many
teaching hospitals have programs for indigent care. Hospitals have
Departments of Social Service and those professionals who are Medical
Social Workers can work with him to see what assistance he may qualify for and help guide him through a bureaucratic maze.
But I am also confused as to why this young man is “in pain” and
requires pain medication. Diabetes mellitus, even when poorly
controlled, does not commonly cause generalized “pain.” Poorly
controlled diabetes can lead to intestinal problems which can be
uncomfortable but not such that “pain pills” (I presume you mean
narcotics) are given. Indeed, narcotics may worsen intestinal motility.
Maybe he has pancreatitis? This can cause severe, excruciating pain,
both chronic and acute. This is addressed with proper attention to diet
and possibly alternative forms of nutrition, pancreatic digestive
enzymes, and pain medications.
Offhand, I’d suggest he seek healthcare at the state or close regional medical
[Editor’s comment: I notice he is your nephew. He is an adult, able to make his own decisions, and may have considerable information about his own situation, and simply choosing not to share with you or others.
He should be seen at an emergency room if he has an acute problem — by law they cannot refuse to treat him because of inability to pay. In addition, his present doctors should explain to him what’s going on (if they haven’t already), and make appropriate referrals to specialists if they are unable to handle his situation.