<한인환자 돈없고 말안통하고 치료못받아 숨져>
(뉴욕=연합뉴스) 추왕훈 특파원
미국 뉴욕에서 뇌출혈 증세를 일으킨 한국인 환자가 의사소통 능력 부족과 미국 의료 시스템 및 의료보험 제도에 대한 무지, 엄 청난 금전적 부담 등으로 인해 제대로 치료받지 못한 채 한달 이상 고통에 시달리다 결국 숨졌다고 뉴욕 타임스가 26일 보도했다.
타임스는 전문가와 해당 병원 관계자들의 말을 인용해 한국인 환자의 죽음이 해 당 병원들의 진료거부로 인한 것이라고 단정할 수는 없지만 의료보험이 없는 환자에 게는 종종 제구실을 하지 못하는 미국 의료체계의 맹점을 단적으로 드러내고 있다고 지적했다.
신문에 따르면 한국에서 목수일을 하던 문철선씨가 자녀 교육을 위해 관광비자 로 미국에 온 것은 10개월 전. 보스턴의 친척 집을 거쳐 뉴욕시 한인 밀집지역인 퀸 스의 플러싱에 자리잡은 문씨는 건축현장 등에서 일하면서 나름대로 행복한 미국생 활을 즐기고 있었다는 것.
그러나 미국에서도 틈만 나면 축구를 즐겼던 문씨가 지난 6월6일 한 고등학교 운동장에서 열린 축구시합 도중 극심한 두통을 느끼고 집으로 돌아갔다 통증을 참지 못하고 앰뷸런스에 실려 갔던 것이 문씨와 가족들이 겪은 고행의 시작이었다.
플러싱 병원 메디컬 센터 응급실에 실려간 문씨는 단층촬영을 한 뒤 뇌출혈 분 야의 전문가들을 확보하고 있는 자메이카 병원으로 옮겨졌다. 이 병원에서 다시 단 층활영을 한 문씨는 병원 직원들로부터 72시간동안 기다리라는 이야기를 듣고 대기 하다 6월9일 퇴원지시를 받았다고 문씨의 부인이 밝혔다.
이름을 밝히기를 거부한 문씨의 부인은 “퇴원할 때 받은 유일한 지침은 타이레 놀(두통약)”을 복용하라는 것 뿐이었다”고 말했다. 병원직원들은 문씨가 퇴원하기 전 의료보험이 있는지를 물었고 문씨 부인은 “없다”고 대답했다.
문씨 부부는 거의 영어를 하지 못했고 병원에 있던 통역은 한국말을 거의 하지 못해 이들은 병원과의 의사소통에 혼란을 느꼈지만 어쨌든 병원직원들이 말한대로 두 차례 병원을 더 찾았으나 문씨는 제대로 치료를 받지 못했다.
문씨 부인은 퇴원 후 두번째로 이 병원을 찾았을 때 이전 입원비와 치료비 등 으로 모두 4천500달러의 병원비를 부담해야 된다는 사실을 처음 통보받았고 이 돈 을 갚을 수 없었던 문씨는 그 이후 다시는 의사를 만날 수 없었다고 말했다.
병원측은 문씨가 6월30일 의사와 면담 약속이 잡혀 있었으나 그가 이 때 나타나 지 않은 것으로 봐서 의사소통에 문제가 있었던 것으로 보인다고 해명했다. 병원측 은 또 6월21일에 추가로 실시된 단층촬영 결과에는 아무런 문제가 없었다고 밝혔다.
그러나 문씨 부인은 아무도 자신에게 이런 사실을 알려주지 않았다고 주장했다.
문씨 부인은 또 극빈자 의료보호 프로그램인 `메디케어’를 신청할 수 있다는 말 도 들었지만 자존심과 자신 및 자녀들의 체류지위에 영향을 미칠 것이라는 우려 때 문에 이를 거절했다고 말했다.
두통을 참아가면서 건축현장에 다시 일하러 나갔던 문씨는 7월6일 극심한 두통 으로 다시 앰뷸런스에 실려 플러싱 병원으로 후송됐고 거기서 뇌의 응혈이 발견돼 브루크데일 대학병원으로 옮겨져 두 차례 수술을 받았으나 결국 숨졌다. 문씨 부인 은 이 병원의 담당의사가 “왜 이 환자를 더 빨리 병원으로 데려오지 않았는가”고 물 었다고 밝혔다.
뉴욕 타임스는 문씨의 사례는 그와 마찬가지로 의료보험에 가입하지 않은 수많 은 환자들이 응급실에서는 치료를 받을 수 있도록 주법에 의해 보장받지만 일단 퇴 원지시를 받고 나면 제대로 후속 치료를 받지 못한다는 문제를 잘 드러내주고 있다 고 지적했다.
cwhyna@yna.co.kr
관련 Times기사
July 26, 2004
Immigrant’s Tale of Navigating Tangled Health Care Maze Is Instructive
By MARC SANTORA
oon Chul Sun’s head was throbbing, so painful it was a struggle to stand.
For three days, after being taken to the emergency room at Jamaica Hospital Medical Center in Queens because of a soccer injury, Mr. Moon, a Korean here on a tourist visa, barely moved from his hospital bed, largely unable to communicate with the doctors and staff because he spoke no English.
He just waited.
Mr. Moon’s wife pleaded in Korean with people at two different hospitals who often did not fully understand what she was saying, begging for someone to ease her husband’s pain or at least explain to her the mystery of his illness. After 72 hours of fractured conversations and a series of medical tests, a translator arrived to tell Mr. Moon’s wife that her husband was being discharged.
“They said, ‘Just take some Tylenol,’ ” Mr. Moon’s wife said.
One month and several confounding hospital visits later, Mr. Moon was dead, and his wife says she was told that the cause was an injury to his head.
In the arc of his 34-day journey through the medical world, Mr. Moon struggled to understand his options even as what ailed him remained a mystery to his family because of communication problems.
There were confusing conversations about insurance and a staggering bill that left his family reeling. There was the option to apply for Medicaid, which was declined by the hard-working family, a decision fueled in part by pride, fear and a lack of information. There would be friends and neighbors drawn into the story, brought along to try and help the family understand exactly what the medical professionals were saying or concluding.
In the end, there would be death and anger.
The hospitals say they did everything they could for Mr. Moon, performing a battery of tests, directing him to the Medicaid program and even scheduling a follow-up appointment that he did not keep. While unable to go into specific details because of privacy concerns, officials at the hospital system that treated him suggested that Mr. Moon’s original injury appeared not to have been related to his cause of death.
But, as public health experts and even officials of the hospitals that treated him acknowledge, Mr. Moon’s death illustrates the flaws in a health care system that all too often can seem broken to those without insurance – riddled with cracks and complications that are compounded when cultural taboos and language barriers are thrown into the mix.
For the most vulnerable, emergency rooms are the place of first resort. At least there they are assured treatment. Once discharged, they often have no contact in the medical community and become lost in a system that can barely handle the problems on its doorstep looking to come in, much less those already sent back outside.
Hospitals feel overwhelmed, and patients feel as if they are treated not as people but as problems. Confusion about coverage is the rule, and basic communication is often imperfect.
And in New York, where the number of people with no health insurance is nearing 27 percent, not including undocumented immigrants, the problem is all the more urgent, patients and practitioners say.
David P. Rosen, the president of MediSys Systems, which owns and operates Jamaica, Flushing and Brookdale hospitals, said, “You have a system that doesn’t work.”
Congress, he said, has systematically sought to eliminate a whole class of people from being eligible for assistance. Yet, he said, his hospitals provide a standard of care that is top-notch regardless of the patients’ ability to pay. Still, he said, the health care system has largely “written these people off.”
A Widow Remembers
Mr. Moon’s wife, 44, who asked that her name not be used because she feared public exposure could cause her children trouble, told the story of her husband while sitting on the floor of the family’s one-bedroom apartment in Flushing, Queens. As she held her head in her hand, wiping away frequent tears, she related the details of her husband’s hospital treatments. Her sister-in-law, Young Sook Kim, who traveled to America to attend Mr. Moon’s funeral, sat next to her and picked up the story when Mr. Moon’s wife became too emotional to continue. Both women spoke through a translator.
Mr. Moon arrived in America 10 months ago, after having saved enough money to try to gain a foothold in this country. A skilled carpenter in South Korea, he came with the aim of eventually gaining a green card because he wanted his children to be educated here.
After staying with a relative in Boston, Mr. Moon moved to Queens, where he felt that given the borough’s large Korean community, he could communicate and find decent work. There are some 62,000 Koreans in Queens. After six months, Mr. Moon’s wife, two daughters – 15 and 13 – and son, 12, joined him.
“He was happy because he found this place good for his children,” Ms. Kim said. “He was healthy, very strong and he played soccer every day.”
On Sunday, June 6, at 6:30 a.m., Mr. Moon went over to the local high school to sign up for the summer league and play in a match. During the game he got sick, said his wife. He returned home early, around 9 a.m., complaining of a headache. He thought it might have been the result of a being hit hard in the head by the ball, his wife said.
By midnight the headache had not gone away, and Mr. Moon’s wife called for an ambulance. He was taken to Flushing Hospital Medical Center. He was given a CAT scan, Mr. Moon’s wife said, and a translator said that it showed a blood build-up in a vein in his brain.
Hospital workers told the couple that Mr. Moon would have to be taken to Jamaica hospital, because it had specialists trained to handle such cases, his wife said. There, workers gave Mr. Moon another CAT scan, according to his wife, and told him to wait 72 hours. Mr. Moon’s wife said he was discharged on June 9, with the sole instruction, as the couple understood it, to take Tylenol.
Before they left, Mr. Moon’s wife said, hospital workers asked if they had insurance, and she replied that the family had none.
“He was still sick,” Mr. Moon’s wife said.
She said that the translator at the hospital spoke little Korean and that they left confused. Workers there told them to return to the hospital in 10 days, his wife said.
Dr. Jam Ghajar, the chief of neurosurgery at Jamaica and who works at the other MediSys hospitals, says that head trauma is the leading cause of death among young people – roughly two million cases are treated annually – and that discharging a patient whose CAT scan shows that bleeding has stopped is standard.
But the problem for Mr. Moon, and thousands of other uninsured patients like him, is that while it is against state law not to treat patients who show up in the emergency room, once discharged, these patients enter a much murkier world, where follow-up treatment is often inadequately discussed.
“The experience is daunting and complex,” said Adam Gurvitch, the director of Health Advocacy, a group for the uninsured. “Fortunately, we hear few stories that end in death.”
‘It’s Not Just the Language’
Mr. Moon and his wife returned to Jamaica hospital on June 18, but this time he did not go to the emergency room. He was still suffering severe headaches and spending most of his time on his couch at home, and his wife said that workers there told him that he had to pay $95 to see a doctor. After paying the money, Mr. Moon’s wife said, a doctor told the couple that tests could not be run that day, and that they should come back on June 21.
On the appointed day Mr. Moon showed up, accompanied by his wife and a neighbor who spoke English.
Mr. Moon’s wife said that hospital workers told them that a CAT scan would cost $552 and that they would have to pay at least half of the cost to get the test run. They paid, the test was run, and the couple and their neighbor went home to wait for the results. Mr. Moon and his wife returned to the hospital a few days later, this time with their oldest daughter, who spoke a little English. The hospital said they had to pay $95 to see the doctor again, and told them for the first time that they owed $4,500 for Mr. Moon’s previous hospitalization, Mr. Moon’s wife said. They could not pay.
Mr. Moon’s wife said they never got to meet with a doctor again.
Mr. Rosen, the MediSys president, could not explain what specifically happened in this case, citing patient privacy laws, but said that hospitals officials had reviewed the case and were confident that they had done everything right. He added that his hospitals never refuse to treat patients, even those who can not pay. He said that there might have been a communication problem, because there had been an appointment for Mr. Moon to meet with a doctor on June 30, an appointment he missed. Mr. Rosen also said that the follow-up CAT scan on June 21 showed no new problems.
But Mr. Moon’s wife said that no one had shared that fact with her.
She said that the couple had set about trying to make sense of their payment options. They were told they could apply for Medicaid, but hesitated. “It means being poor,” Mr. Moon’s wife said. “We did not want our children to grow up with that stigma.”
She also said she worried that if the family took the assistance, their children’s chances of getting green cards would be jeopardized. When they asked a woman working in the Medicaid office for guidance, according to Mr. Moon’s wife, she replied, “It may or it may not.”
In Mr. Moon’s case, a medical emergency, it would not have, according to immigration lawyers.
Immigrant families entertain such fears all too often, according to Dr. Bruce C. Vladeck, a professor of health policy at Mount Sinai School of Medicine.
“In these cases, seldom is it one thing alone that goes wrong,” said Dr. Vladeck, who was in charge of Medicaid and Medicare programs during the Clinton administration. Dr. Vladeck noted that New York hospitals are more generous than those in other states in treating the uninsured and immigrants, particularly hospitals like Jamaica. But he said navigating the complexity of the system was still hard for many patients. “It’s not just language, it’s cultural, too,” he said.
Proceeding on Their Own
Mr. Moon and his wife decided to try and pay off the debt on their own.
For days, Mr. Moon’s headaches continued, and the hospital did not contact him, his wife said. On July 6, Mr. Moon decided to get off the couch and go to a construction site to help a friend work on a kitchen.
While there, he became violently ill, an ambulance was called and he was taken once again to Flushing Hospital. Tests this time showed that there was blood in his brain that had clotted, his wife said. He would need emergency surgery.
He was transferred to Brookdale University Hospital and Medical Center. Two surgeries later, he was dead.
Mr. Moon’s wife said that the doctor, whose name she could not recall, asked her, “Why didn’t you bring him in sooner?”
Natalie Woods, who works in Attorney General Eliot Spitzer’s office in the civil rights bureau and who conducted a year-long study on the subject, said there was no excuse for the language difficulties Mr. Moon encountered.
“The language problem is pervasive,” she said. Elizabeth Benjamin, a lawyer at the Legal Aid Society, said the problem went beyond language. She said that the three hospitals where Mr. Moon was taken receive a total of roughly $70 million to deal with charity cases, and that they often shirk that responsibility.
But Mr. Rosen said that such criticism was unfair because the hospitals spend roughly $120 million a year on uncompensated care, a burden that falls disproportionately on hospitals like Jamaica that do their best under trying circumstances.
Mr. Moon’s wife is just trying to make sense of it all. With her three children and a $1,200 monthly rent payment to make, she said she did not know how much longer she could stay here but she needed answers.
She recalled the last words of her husband, as they rushed to the third and final hospital he would visit.
“He said, ‘I don’t understand,’ ” she recalled. “I don’t understand why I am sick like this. I can’t be sick like this.”