No insurance,
no doctor,
nowhere to turn
An Oahu woman died for lack
By Helen Altonn
of care, one of a growing number
of medically uninsured in Hawaii
Star-BulletinThe Oahu woman died last June of a perforated ulcer without ever seeing a doctor. She was a 39-year-old single parent with a 13-year-old son and no medical insurance.
"She just didn't have money to pay for it," says the boy's guardian, who asked not to be identified to protect her "buddy."
The woman's death is a tragic example of Hawaii's growing medically uninsured population.
House Human Services Chairman Dennis Arakaki believes there are many other cases where people aren't getting health care for various reasons. "They may show up in an obituary, but you never know the story behind it."
In this case, the boy's father died in 1992. His grandmother, who had lived with him and his mother, died in January last year. He found his mother dead June 16.
"The police department called me to pick up the boy," said the guardian, a family friend and "aunty" to the youth. "Before, she signed a will that I had guardianship if anything happened to her."
The boy's mother had pulled herself off welfare with a part-time job as an education assistant, the guardian said. "She ended up working for the school that my buddy was going to. It just wasn't enough to pay bills."
Rent took about 75 percent of the woman's income, and she couldn't afford medical insurance, according to the guardian. "When she was under welfare they were covered. Then when she was working they were off."
She signed the mother up for the state's QUEST health-care program two years ago, she said. "Then they turned around and denied her because of her income."
The boy receives a monthly Social Security payment of about $700, which QUEST counted as income with the mother's earnings. A grandfather who died on the mainland also left the boy a trust fund that he can't use until he's 21, the guardian said.
Ann G. Tam Sing, Med-QUEST eligibility administrator, acknowledged that the boy's mother was enrolled in QUEST and then taken off the program.
Tam Sing said she couldn't provide any details because of client confidentiality but "we didn't close her out because she had too much income."
The guardian said the woman couldn't afford the premiums to remain in a state health plan, then ranging from $145.62 to $155.29 per person monthly.
She said the woman ran up about $1,500 in medical bills on QUEST before benefits were cut off. All of the bills were for treating the boy, who is asthmatic, the guardian said.
The woman had been having stomach problems on and off for some time, the guardian said. "When grandma passed away, she started really going downhill. I guess the stress was getting to her."
Beth Giesting, Hawaii State Primary Care Association executive director, said if the woman had gone to a community health center, "We would have made sure she got into a hospital.
"Hospitals will take care of people when they get to that point, even if they are medically indigent."
The guardian said she called her friend last Mother's Day. "I knew she'd be upset (because of her mother's death). Then, June 16, I got a phone call from the police department."
She said the boy told her his mother had been crying and having nightmares the night before he found her dead.
The boy, who will be 14 this month, is "really having a tough time" and is receiving counseling, his guardian said.
She arranged for him to live with a family he knows because she didn't want him to remain with her in a single-parent situation, she said.
She also has some medical problems and didn't want him to end up caring for her as he did for his grandmother and mother, she said.
"I told him from the beginning I want him in a regular family . . . I'm very, very thankful for the family taking care of him. I love them to pieces; they're so neat.
"He's doing fine there. It's a little hard for him to adjust. He was a single kid with a single parent. Now there are other kids with him."
She said she tried to get the family licensed as a foster family but couldn't because the boy isn't in the court or child welfare systems.
She gives the family money from the boy's Social Security payments. She also got court permission to draw limited funds from his trust account for his care, with a lawyer's approval.
One of her biggest problems has been trying to get medical insurance for the youth.
"Going on eight months, everybody told me I couldn't get QUEST because of his trust fund," she said. "It just put a strain . . . on the kid."
She said she called five health plans and couldn't find anything appropriate for the boy. She even went to the Legislature for help, noting President Clinton's Bill of Rights for patients.
"All kids should be covered," she said.
The Hawaii Medical Service Association was trying to work something out for the youth last week. Then QUEST learned after a reporter's inquiry that an error had been made.
The boy's trust fund was being counted as an asset that would put him over QUEST's income limit, Tam Sing said. "That was wrong. He was too young."
When she discovered the mistake, she met with the boy's relieved guardian and immediately signed the boy up for medical benefits.
"He's a great kid," the guardian said. "He's got a lot of talents. He's smart. He can draw really well. He enjoys cars and movies and going to the beach with his friends."
He likes to play volleyball but "grades come first," she said. "So I had an ultimatum for him that he had to maintain a certain grade point average. We did let him play volleyball during that time.
"He's grown up too fast. We want him to be a kid again."
She calls him and picks him up after school to "go to McDonald's, the regular thing," she said.
"I think he's doing as well as can be expected. I grumble about a couple grades, a B-minus that is almost a C.
"He says, 'It's a B. Don't look at the minus.'"
No insurance
According to a 1996 state Health Department telephone survey, Hawaii's medically uninsured include:
About 103,000 residents, based on a conservative estimate of 9 percent of the population.
