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Jan. 24, 2009
Copyright © Las Vegas Review-Journal DOCTORS PICK UP THE SLACK Treatment offered after some UMC's services were discontinued 
Listening to Vince Gill on her iPod and with a Danielle Steel book tucked close by as backup for potential boredom, Margaret Frye-Jackman sat in an infusion recliner, her legs propped up as if she was resting at home instead of undergoing a five-hour round of chemotherapy. Next to her, Maria Cuellar, a 42-year-old mother of four, sat with a red blanket over her legs staring into a corridor inside the Women's Cancer Center of Nevada on La Canada Street. Although both women approach the hours-long chemotherapy infusion process differently, they share a special appreciation for their gynecologic oncologist, Dr. Nick Spirtos. Had Spirtos not turned a storage room at his practice into an infusion center after University Medical Center's decision to stop providing outpatient oncology services, the two women might still be searching for cancer treatment. "I was really upset when I heard about that because I didn't know where I was going to go,'' Frye-Jackman said about UMC's decision. The 71-year-old has ovarian cancer. In August she underwent a complete hysterectomy at UMC and was to undergo chemotherapy. After two rounds, she learned UMC was discontinuing the service. Though Frye-Jackman didn't experience a delay in treatment, the Henderson resident believes her situation might have been different had Spirtos not transformed his storage room about a month ago. "I might not be getting any treatment,'' she said, stretching her legs. Spirtos said he and his colleagues had no choice but to continue serving their patients. Because there were limited opportunities for his patients to receive the service elsewhere in Las Vegas, the practice hired an oncology nurse and turned the extra space into an infusion center. Currently there are 23 active patients undergoing chemotherapy treatments at his office. Three of the patients have neither health insurance nor any means to acquire it. At least one of those uninsured patients lives in a shelter. "She can't pay. Zero,'' Spirtos said. "We are totally eating the costs of her care, and that's not a problem. It's a decision we're living with. We're doctors. We care for people. If you can pay $50, you pay $50. We work out the rest.'' Spirtos said the majority of his patients are Medicare or Medicaid recipients. Medicare is the federal health care plan for seniors and the disabled while Medicaid is a state-run health plan for the poor. Neither reimburses the full costs for treatments, Spirtos said. In many cases the patients are left to pay the rest, which he said can be tens of thousands of dollars. Because of financial considerations, UMC on Dec. 31 stopped providing outpatient oncology services. That meant patients who were undergoing treatment there, or had planned to in the future, needed to find other avenues to receive care. Considering the majority of the patients treated at UMC are uninsured, the working class poor or insured by Medicaid and Medicare, some have had a tough time finding those services. Many of Nevada's physicians can't afford to take on oncology patients without reimbursement because the chemotherapy drugs can cost up to $12,000 per round. Though most of his patients are eligible for experimental drugs, which are provided at no cost by pharmaceutical companies, Spirtos says it's the "front-line" cancer drugs physicians worry about. The "front-line" drugs are ones that aren't considered experimental. They are typical drugs patients are initially prescribed as opposed to those given during a recurrence of cancer. These drugs, he said, cost $200 to $250 per month per patient. The costs of cancer drugs have become the topic of many discussions recently, said Clark County Commissioner Rory Reid. On Jan. 15, Reid and other local leaders met with area health care providers and patient advocates to explore ideas on ensuring Southern Nevadans receive proper and timely outpatient oncology services in the wake of UMC's decision. "The major focus was on how to get discounted drugs that are available to certain patients,'' Reid said. "We want to make that availability more broad-based. We have a couple of technical working groups getting together to talk about access to existing resources that might help us.'' Reid said in some federal programs pharmaceutical companies are responsible for providing cancer drugs to patients at low cost. However, he said there's a "significant administrative burden to access" those drugs. "Our job is to help patients navigate the bureaucracy,'' Reid said. "We need to create some synergy between all the different providers and patients so this can be done. ...The community has looked to UMC for many years to solve its medical problems. This is a community problem. UMC doesn't have the resources it once had to solve it.'' Though Reid called last week's meeting productive he said he was surprised representatives from private hospitals didn't attend. He hopes they will attend future sessions. Jackie Brown, executive director of Susan G. Komen for the Cure Southern Nevada affiliate, also attended last week's meeting. Her outlook isn't upbeat. She said Southern Nevada's outpatient oncology situation has drawn national attention and will likely get worse rather than better. "Other states are going through similar budget issues. It just seemed to hit Nevada first,'' Brown said. "We know it's going to get worse, like next week." Brown and her staff used to refer patients to UMC for cancer treatment. Her work is more difficult now. Though she is finding help for most, some are falling through the cracks because they can't pay. "There are a couple that can't get any help,'' she said. "I don't think anyone has a solution nor do I think we'll ever get one.'' Spirtos said he's hoping to generate public support by soliciting donations from local businesses to pay for cancer drugs. He plans to distribute 500 collection boxes to local businesses. "This money would be used directly to help patients get medications,'' Spirtos said. "I owe it to my patients to try." Contact reporter Annette Wells at awells@reviewjournal.com or 702-383-0283. 
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