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‘Caught in the middle’ / June 23, 2014
Danville Register&Bee
Reprinted with permission

Cathy Haskins is in end-stage liver failure. The organ could give up at any time. Her doctor’s latest prognosis is she is “holding.”

“Every time she tells me I’m ‘holding,’ I feel blessed,” said the Chatham resident.

Haskins started feeling poorly in 2009, with heavy fatigue. She started to retain fluid. Her legs swelled, and her balance faltered. Her mobility decreased, and jaundice set in.

She thought she would pull out of it, but instead became bedridden.

“I stayed in bed for awhile, thinking things would get better,” she said.

Her husband, Michael Nava, worried.

“He asked me if I wanted to go to the doctor, and I said ‘no,’” she said.

It was the winter slowdown for Michael, who works for a lumber company, and the reduced hours meant he took home just $100 a week.

“I wasn’t working,” she said. “We were trying to just keep food on the table.”

To Haskins, a doctor’s appointment was a luxury they could not afford.

“When you don’t have money and you don’t have insurance, it’s hard to see a doctor,” she said. “It’s sad.”

Finally, she saw a doctor at Piedmont Prime Care, who told her she needed to immediately go to the hospital. She protested, because she didn’t have insurance. Had she waited much longer, she wouldn’t be around to tell the tale.

“I didn’t realize how serious my situation was,” she said.

After a five-day stay at Halifax Regional Hospital and working with doctors from Danville’s Piedmont Access to Health Services (PATHS), Haskins was diagnosed with autoimmune hepatitis, in which her body’s immune system attacks her liver.

The disease causes cirrhosis of the liver. Every day, Haskins takes six medications and two vitamins. They include pills to alleviate fluid buildup, rid her body of toxins, and cope with the side effects of the medications. She takes blood pressure medicine to reduce pressure on the artery to her liver, which could burst and kill her. Her esophagus is banded to prevent rupture, another potentially fatal complication of her illness.

“I’m just living on borrowed time,” she said.

Paying for care

Haskins and her family would quickly learn about the cruelties of her illness and of facing the bills.

“I didn’t have the money to pay,” she said.

Halifax Regional eventually sued to recover $2,000 of the debt and succeeded in obtaining a judgment, according to court documents. The couple said they had just $25 a week to live on after Michael’s wages were garnished.

There have been at least a dozen hospital stays since then, including a stay at Danville Regional Medical Center and many at Carillion Roanoke Memorial Hospital. One stay in Carillion’s intensive care unit resulted in nearly $300,000 of debt to the hospital and connected services. Sixty percent of the hospital’s bill is being covered by its charity care program, said Haskins, but she still can’t afford it.

“I’m in collections on some of that stuff,” she said.

What Haskins needs is a liver transplant, but her financial situation has made that impossible. Besides proving her physical need for a new liver, she has to prove she can pay for it and the expensive anti-rejection medications needed afterward. That means insurance or Medicaid — but she has been unable to get either.


Haskins has fallen through every conceivable safety net. Michael makes too much money for the couple to qualify for Medicaid, but they can’t afford insurance. They also have a son in college. They would be covered under the Medicaid expansion — a long-running bitter political battle.

Gov. Terry McAuliffe vowed Friday to bypass the General Assembly and expand Medicaid eligibility for about 400,000 low-income residents on his own, a move Republican lawmakers immediately promised to fight.

Republicans accused McAuliffe of throwing a “tantrum” and said they are willing to sue him in order to prevent a unilateral Medicaid expansion.

McAuliffe said he’s consulted with Democratic Attorney General Mark Herring’s office and believes there are number of ways to legally expand Medicaid without the General Assembly’s approval. He mentioned a possible “public-private” partnership, but did not offer any other details.

Not eligible for help

Neither is the couple eligible for Social Security, disability, nor other forms of assistance. So Haskins goes without: without a new liver, without supplemental oxygen she sometimes needs, without up-to-date glasses, without hearing aids, and even without several teeth. Haskins says cleaning staff at one hospital tossed out her dentures while she was out of the room for diagnostic imaging. She is self-conscious about the gap in her smile.

There is one area in which she has hit the jackpot: her family, who have pulled together to advocate for her and see to her needs. Her son and daughter-in-law, Donnie and Dana Yeatts, make her meals, take her to doctors, and help out financially as much as they can. Dana has racked up mad minutes on the family’s shared cell phone plan to explore options for buying Obamacare.

“I spent hours on the phone,” Dana said.

Dana said it seemed every representative she spoke to had different information, and she sought most of the information, unassisted, on the Internet. When the process was finally complete, after several tries, Haskins qualified for a $30 subsidy, with a premium of $515.15 a month. She is the only one on the policy.

“Five hundred and twenty dollars a month is not affordable insurance,” Donnie said.

Donnie is a full-time mechanic and is picking up odd jobs to be able to take on the cost of his mother’s policy in addition to supporting his wife and their 12-year-old daughter.

“I work seven days a week,” he said. “I need eight days.”

PATHS steps in

Tracy Chandler, Haskins’ patient navigator at PATHS, helped Dana narrow plan choices for Haskins.

“I hate to see her family having a tough time,” Chandler said.

They believe Haskins’ doctors in Roanoke and PATHS in Danville will be in-network with the new policy, but they aren’t sure how the transplant process would work with it. Do they need a policy that includes a hospital such as the University of Virginia, which can do transplants, in it? They don’t know.

The family is weary of the hoops, loopholes and bureaucratic wrangling that keep Haskins just out of reach of a much better life.

“I don’t really believe in the system,” Donnie said.

Meanwhile, Chandler says Haskins is racing against time. PATHS is trying to secure medicine required to prepare Haskins for a transplant, hoping she can finally get on the list. If the disease progresses much further, Haskins will be considered ineligible. And if she can remain eligible, the wait for a match is still an issue — even if her serious condition would rocket her to the top of the list.

“She’s one of those that’s just caught in the middle,” she said. “She’s just not going to be here that much longer if we can’t get her on the list.”

Haskins says the system has failed her.

“People need help,” she said. “The state of Virginia should give them help.”

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The suffering of many for the profits of a few. Forever indebted, even in death.


Charity does not come from the state. Besides the "state" is too busy protecting oil contractors in Irag and chasing mineral deposits and guarding poppy fields in Afghanistan. And don't forget about the money it has to spend shipping "unaccomanied alien children" all accross the country.

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