A sick woman's odyssey without health insurance

The "abdominal pelvic complex cystic mass," as the ultrasound report calls it, measures 32 to 35 centimeters - the size of a football - and may be malignant.

Everyone she has seen sent her somewhere else. The emergency room at Temple University Hospital referred her to a city clinic and back to a state welfare office and then sent her home.

She had no insurance.

"We got turned down from everybody I tried," she said this week, in her Logan home, six weeks after learning about the tumor inside her. "I can't wait till I'm 65 to get Medicare. I'll probably be dead by then."

Her experience shows how difficult it can be to get care without insurance. Only after an Inquirer reporter asked for explanations did public agencies involved in her case start to respond, promising help.

Ruby, a homemaker with no work experience, was married for 24 years but has been a widow now for 12. She survives on $23,664 a year - $10,848 from her late husband's pension from the city recreation department, and $12,816 from a Social Security widow's pension.

She has lived in the same rowhouse for 30 years and attended the same church for 35.

She knows she is partly responsible. Insurance would have consumed much of her income, but she did not try to buy it when she was well.

"I didn't think I would get sick," she said.

And she was not seeing a doctor regularly.

Over the summer, she noticed she was getting thick around her middle. It seemed normal. "You get to a certain age, and you start spreading," she said.

But she soon realized something was wrong. She saw an advertisement for Svetlana De John, a physician assistant, and paid $45 for a visit, and then $125 for an ultrasound. The report, dated Sept. 8 and signed by Anthony J. Limberakis, M.D., of Bustleton Radiology, states in bold type: "PHYSICIAN ATTENTION REQUIRED."

"Findings suggest a huge ovarian carcinoma or other benign or malignant neoplasm. CT (scan) of the chest, abdomen, and pelvis as well as gynecologic follow-up are advised."

De John, Ruby said, told her "to go to welfare and get coverage."

On Sept. 11, Ruby and her son, Dennis Spencer, went to the county assistance office in Germantown to apply for medical assistance. They sat for an hour and a half in the busy waiting room and then met with a caseworker.

"Once I gave her my income," Ruby recalled, "she told me I would not be eligible for medical assistance."

In a meeting that lasted a few moments, she said the welfare worker also told her she could apply to adultBasic, a state insurance plan for the working poor. But getting it takes at least a year, and 118,000 Pennsylvanians are on the waiting list.

She said the welfare office worker also told her, in the meantime, "if you have any problems, go to the emergency room."

So Ruby and her son went straight to Temple's ER on Sept. 11. They arrived about 1 p.m.