OLDER CITIZEN FACES DILEMMA SECURING DOCTOR

Left without a family doctor, Medicaid patient Lola Long must depend on hospital emergency rooms if she gets sick.

Long's physician moved her practice from Cape Girardeau to Bloomfield earlier this month.

Jackson resident Maxine Tibbs, Long's stepdaughter, said she has called other doctors' offices, but hasn't found another doctor that will take her stepmother as a patient.

Long, 88, lives in Cape Girardeau in Lindenwood Apartments. She has a small, third-floor unit -- subsidized housing that allows her to get by on Social Security income of $553 a month.

Long suffered a broken right shoulder seven years ago and the bone has since decayed. "I can't even raise my arm," she said.

The woman -- who now must eat with her left hand -- still manages to cope, with the limited assistance of a homemaker aide.

She takes medicine for a heart problem. "I get five kinds of pills," said Long.

Among other things, Long has two leaking heart valves. "If she doesn't get the medicine, she swells up with this fluid all over her body," said Tibbs.

"She has to have the medicine or she will die," said Tibbs.

Pharmacist Bill Smirl said that without the medicine, Long would die of congestive heart failure. "She has had a bad heart for years," he said.

Long has had two operations in the past three years, which cost about $68,000, said Tibbs.

In May 1991, Long underwent surgery because of blocked heart valves, a ruptured appendix and gangrene.

A year later, she passed out on a church parking lot and had to undergo an operation because of blockage of an artery on the right side of her neck.

"She didn't have a pulse for five minutes. They thought she was dead," said Tibbs.

"They (doctors) said they couldn't kill me," Long added with a smile.

"She doesn't need to be in a nursing home," said Tibbs.

In the last couple of years, Long has gone through a succession of doctors, all of whom ended up leaving the area.

This last time, when Long's doctor moved away, Tibbs was immediately concerned about how she would get her stepmother's prescriptions refilled.

Pharmacists can't refill prescriptions without authorization from a physician. Long's medicine, which is prescribed for six months at a time, was set to run out in June.

Tibbs said she began calling doctors' offices and even the county medical society.

Part of the problem, she said, is that private doctors don't want to treat Medicaid patients for which they are poorly reimbursed by the government.

"We have just been shoved around trying to get her prescription filled," said Tibbs.

Dr. C.R. Talbert Jr., a Cape Girardeau cardiologist, agreed to continue prescribing the medicine, Tibbs said. Talbert previously had treated Long for her heart problem.

Tibbs said Long could have gotten the prescriptions filled by going through either of the emergency rooms at the two Cape Girardeau hospitals. But, she said, emergency room doctors will prescribe medicine for only short periods of time.

As a result, said Tibbs, they would have had to go back to the hospital every two weeks to get a new prescription.

The prescription problem has been resolved in Long's situation, but she still has no family doctor that she can go to if she gets sick.

"That isn't a good situation," said Tibbs.

Local health care professionals agree.

"It is a real big problem. The old people on Medicare and Medicaid, they can't find a doctor to take them," said Smirl of Bill's Family Pharmacy.

Even Medicaid patients, who have had regular doctors in the past, often find themselves out in the cold when their doctors move out of the area or retire.

Many Medicaid patients find it difficult to get prescriptions filled.

Smirl said he and his pharmacy staff have called doctors' offices on behalf of patients who no longer have a regular doctor but need a prescription refilled.

"You are in a real sticky wicket here," said Smirl. The patient needs medicine. But under the law, if the doctor -- who prescribed the medicine -- leaves or retires, the pharmacist can no longer fill the prescription, he said.

Doctors don't want to take Medicaid patients because the government pays only a small percentage of the bill, said Smirl.

He blames the government for the health care problem. "They created a system that doesn't work and they won't admit to it."

Referring to the national debate on health care reform, Smirl said: "It's not over care, it's over money."

Dr. Mark Kasten, a family physician in Cape Girardeau, said Medicaid pays about 33 cents on the dollar.

That's not enough for doctors' offices, which have high overhead costs, he said.

"In our office, we have five doctors and about 33 full-time employees," said Kasten.

Kasten said he and other area doctors treat some Medicaid patients. "When Medicaid moms get pregnant, they can all get physicians."

But he said that part of the problem in finding a physician has nothing to do with Medicaid. Doctors, their patient loads at capacity, simply aren't taking new patients, he said.