I-Team: Medical Limbo Could Cost County Millions - 8 News NOW

Investigative Reporter Colleen McCarty and Photojournalist Kyle Zuelke

I-Team: Medical Limbo Could Cost County Millions

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On any given night in southern Nevada, there are patients in hospital beds who don't need to be there. Combined they rack up millions in unnecessary costs while they wait for a bureaucrat to decide whether they qualify for health insurance. Call it medical purgatory, patients known as Medicaid Penders.

In the simplest terms, these people are waiting for the system to process their paperwork. Most are too sick to go home, but not sick enough to stay in a hospital. Without health insurance, nowhere else will take them.

At University Medical Center in room 608, time has stopped. "I kept looking at the clock and that's funny. That clock's not moving," said Brian Wheeler.

Like the second hand, the recovery process too has stalled for 50-year-old Wheeler. Admitted in October for heart surgery, doctors deemed him ready for discharge to a long-term care facility three months ago.

Yet Wheeler remains while the Social Security Administration processes his application for disability insurance.

Virginia Carr is UMC's Director of Eligibility and Placement. "On an average, if a case runs smoothly and it's approved through disability, we can see 120 to 170 days in our hospital setting before we have a pay-source for a long term care facility," she said.

Wheeler is known as a Medicaid Pender. Too sick to go home, he waits in the hospital while the federal bureaucracy decides if he will qualify for tax payer funded health insurance.

Mike Willden is the state Director of Health and Human Services. "It's a big problem if you don't have a guaranteed pay source. The nursing home won't take you and assisted living's not going to take you. The hospital had to take him and they're kind of stuck with him until he gets a pay source," he said.

Wheeler's hospital bed costs $80 more per day than the nursing home bed his doctor's prescribe. The total for his six month stay at UMC, it's nearly $2 million in taxpayer money. That doesn't count the human costs.

"They become sicker, sometimes need on-going intervention through surgery, through medications, through procedures. At that point, your cost raises exponentially. We have had patients debilitate to the point of expiring in the hospital," said Carr.

A policy fix before the state legislature would improve patients care, cut costs, and speed payment to cash-strapped providers. But its multi-million dollar price tag almost guarantees it will fail.

"We shouldn't have to spend $10 or $11 million of state funds to do what the federal system should be doing in a timely manner," said

Far from any policy debate, Wheeler and his friend Jean Davis follow the second hand in room 608. Hoping the patient, like the clock, will soon start moving.

Without that federal approval the county would have to absorb Wheeler's hospital bill. On the day this story was reported, there were 21 other patients just like him at UMC.

The legislature responds to public will. So if you feel strongly about any health care related issue in the community, contact your legislator.

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