Thursday, Nov. 23, 2006 | 6:56 a.m.
Patients who don't have insurance or documentation usually turn to University Medical Center.
Patients without names end up there, too.
Some of these John and Jane Does may arrive inebriated or unconscious, are treated in the emergency room and are sent on their way within hours or days, depending on his or her condition. They show up as unknowns, but are usually identified thanks to cell phone histories, credit card receipts and casino loyalty cards.
But others are delivered by paramedics and ambulance crews to UMC too injured or too out of their minds to know who they are. They may be the most striking among the indigents who receive care at UMC, staying for months at the public's expense.
They typically are housed with other indigent patients in the chronic care unit, where they live dormitory-style, four to a room along the first-floor cement hallways of the 75-year-old hospital. There, they may lie comatose for weeks or months, or be treated for dementia or other mental illness that creates a hurdle in identifying who they are. They may undergo surgery, physical or speech therapy or whatever else that is required to restore them to health. And still, the staff can only make up names for them.
Dr. Robert Mull watches over the lot, presiding over a unit where patients receive millions of dollars in care that most likely will never be repaid. And he's OK with that, because he empathizes with the down and out.
He grew up among uncles who were "bikers and booze fighters." He was around alcoholics, drug addicts and people who were barely on the better side of the law.
Working in the chronic care ward with John Does and indigent patients is "why I can come here and feel good," Mull says.
UMC loses money caring for these people - $18.8 million in 2006 and nearly $50 million in the past four years. Just this week the public hospital caught heat with the Clark County Board of Commissioners for how it manages its finances while providing a medical safety net for the valley's uninsured and indigent patients. Public hospitals across the country similarly find themselves in the same no-win situation of being saddled with the cost of indigent health care.
At UMC - the only Level I trauma center in the region - the Does usually arrive through the emergency room. Many are undocumented immigrants, or have come to Las Vegas to abandon one life in favor of another, and aren't carrying identification. They may arrive unconscious, suffering from head injuries, brain damage or mental incapacitation from chronic alcohol or drug abuse.
"They get hurt, get shot, get in an accident, and nobody knows who they are," Mull says.
Caregivers sometimes name Does according to the day they arrived. There's been a Sunday Doe and a Tuesday Doe. There's also been Donald Doe and Unknown Doe, and they're still talking about Foulmouthed Doe.
Hospital social workers-turned-detectives search urgently for the patients' identities, says Jeri White, UMC's director of social services, because the Does' circumstances are likely unknown to their loved ones. And family might have information that would be integral to the patient's care.
If personal belongings don't offer clues to a Doe's identity, UMC turns to Metro Police, whose missing person's unit can try to match the patient's description to people reported missing, and run the patients' fingerprints through a criminal database.
A recovering patient may provide a name or a birthday, which can be used by social workers to lead to a birth certificate. It's rare for Does to remain unidentified or have long stays at UMC, and once they're identified they lose their John Doe classification. This year only 27 patients out of scores who were initially identified as John Does remained unidentified by the end of their stay, when they were either discharged onto the street - still with no name - or transferred to another facility.
A 52-year-old undocumented Honduran woman remained at UMC for six months, recovering from a car accident that left her with head injuries, a tracheotomy in her neck, feeding tube in her stomach and pins in her leg. The woman was identified through connections in the Honduran community.
UMC paid for the woman's return to San Pedro Sula, the second-largest city in Honduras, where she was reunited with her family.
A 75-year-old Canadian man who came to Las Vegas to strike it rich - only to lose $150,000 - spent three months at UMC as a comatose John Doe after a failed suicide attempt with a handgun. He woke up, remembered who he was and was escorted home to Vancouver.
Even though UMC provides some of the most advanced care in the valley, images of indigent and uninsured patients - who make up about half of the admissions - may scare away insured patients whose revenue is needed by the hospital. In 2006 UMC reported $120 million in uncompensated costs for indigent patients. (In 2005 it was $115 million - triple the costs incurred by Sunrise Hospital and Medical Center, a larger facility that ranks second in the county for uncompensated costs.)
UMC was reimbursed $88 million for indigent care by Clark County and $15 million from Medicaid. The remaining $17 million was a loss, to be offset by paying patients.
Peter Tibone, UMC's reimbursement manager, said UMC's mission is much different from most other hospitals in Las Vegas, which are for-profit companies.
"They operate in a mode that minimizes costs," Tibone said. "They do what's necessary to avoid taking care of indigents. They'll meet the required law if somebody comes into the emergency room, but if they can avoid taking care of someone who has no pay source, they'll do so. Our mandate is to care for everybody who falls sick within Clark County."
It's a mandate that extends to those whose very identities are, at least temporarily, unknown.