Lack of insurance brought diabetic near death

Flower delivery man was hospitalized for $41,000 because he could not get into see a doctor.

Posted: October 13, 2008

Iyasu Habtemicael - Izzy - drives a florist truck for $8 an hour most days and then works nights in a University of Pennsylvania parking garage.

This leaves him little time to exercise, eat right and manage his diabetes.

He also has no health insurance, relying on the city's busy free clinics for care.

Because of these factors, compounded by his own belief that he couldn't get in to see a doctor, Izzy nearly died last spring when his diabetes soared out of control.

In immense pain and vomiting blood, he went by ambulance to Mercy Philadelphia Hospital, where he spent five days in intensive care. The charges came to $41,000.

The nurse practitioner who treated him said it all could have been avoided if he'd had better access to a doctor.

Izzy, 33, a college-educated U.S. citizen, dreams of returning to his native Eritrea in East Africa to be a political science professor. He remembers arriving in the United States with his family when he was 9 years old on July 4, seeing fireworks on the car ride from the airport in New York to Philadelphia.

Izzy learned he had diabetes while at Indiana University of Pennsylvania. His father died from diseases related to diabetes a few years ago.

Izzy had an appointment to get blood work done on Feb. 14 - Valentine's Day, the busiest day of the year for a man who drives a flower truck.

Izzy knew a trip to the clinic could last all day, and he didn't want to let his boss down.

"Izzy is a very nice person," said Michael Toroghi, 64, who owns Roses Florist on the Penn campus. "I'm happy with his performance. He carries out his duty."

Izzy tried to get a new appointment, but just couldn't get through. Press one for English, then hold. . . . He would hold until he was disconnected, then try again. After a few tries, he gave up.

City clinics serve 85,000 Philadelphians who make 334,000 visits every year. Many patients, including Izzy, think the doctors are excellent and committed.

One problem is that it can take months to get a new appointment. A report last spring by the city controller found that it took on average 165 days for a clinic patient to see a primary-care physician. City health officials say that the average wait is down to 55 days and that they are working to reduce it further.

Even though Izzy missed his Valentine's Day appointment and was skipping insulin shots because of his hectic schedule, he thought he would be fine.

He had an appointment with his doctor at the clinic on May 29.

He figured he'd just wait until then.

Izzy ran out of strips for his glucometer, the portable device he uses to measure his blood sugar, and said he didn't know he could just buy more at any drug store. He thought he had to get them at the clinic, so he just did without them.

In May, he wasn't feeling well.

"I knew it was getting bad," he said, referring to his blood sugar, "but what am I supposed to do?" He believed he didn't have a whole day to wait at the clinic. "All I can do is try to eat proper and take my shots."

On May 11, Izzy felt massive stomach pain. He really thought the pain was just bad food from the night before, when he worked a graduation party as a DJ, another side job he sometimes does.

But then he vomited and vomited and finally blood was coming up, and he was in agony, and a friend called the ambulance.

"Crazy pain," Izzy recalled. "Extreme pain. A ton of bricks on my chest. It was that fast."

Izzy was taken to Mercy Philadelphia Hospital at 54th and Cedar in West Philadelphia. His blood sugar was so high that he went into diabetic ketoacidosis - his body, starving for glucose, started breaking down muscle and fat, making toxins that could kill him.

In the ICU, Izzy met a nurse practitioner, Patricia Bevlock, working with endocrinologist Violeta Popii. Bevlock grew fond of Izzy and believed his extreme illness and hospitalization were unnecessary.

"The gist about Izzy is he was a guy who didn't want to take any handouts," Bevlock said, "didn't want to live with his parents. He decided to work two jobs and be responsible for himself. He tried to do everything he could. But there wasn't enough for him there. There was no one to point him in the right direction. He kind of fell through the cracks.

"He was trying to work and be responsible, and he couldn't really wait for the system, because the system requires a lot of time," she said. "If he could have gotten to see a doctor sooner, it could have been avoided."

Bevlock, now working at Mercy Fitzgerald Hospital, also felt the insulin that Izzy was getting from the free clinic was inappropriate for him.

She believed he needed a better class of insulin, and gave him 30 days of free samples, Lantis and Novolog.

Thomas P. Storey, the physician in charge of city clinics, said, "Did she also tell him those drugs will cost $500 a month?"

Philadelphia spends $40 million a year on clinics, $7 million for pharmacy, Storey said. He said the city can't afford to buy more expensive insulin for all the diabetics it treats.

Everyone wants the best drugs, he said. But who pays for it?

"People want the American system for free," he said.

Because of his hospitalization, his diabetes, and his low income, Izzy became eligible for medical assistance from the state for one year.

Taxpayers will pick up most of his hospital costs. The latest bill shows that Izzy owes $5,173.94. He was told that medical assistance would cover that too, but if it doesn't, he says, he'll pay a few dollars a week.

Medical assistance also enables Izzy to get the better insulin at a pharmacy, and to see the specialist, Popii, whom he met recently.

"She told me I need to see a dietitian," he said, "so she can help me out to count calories and teach me to balance out my food and medicine. That was quite helpful. And she gave me some extra medicines. It went well. It felt good. And I'm going to revisit. I have to do blood work, and she has to analyze."

Izzy must apply for medical assistance again next May. The university limits him to part-time hours at the garage, but he is hoping to get on full time, which would entitle him to health insurance.

That's a big reason why he stays.

What Went Wrong

Iyasu Habtemicael is an uninsured diabetic who missed an appointment at a free city clinic due to work. He couldn't get through to reschedule, and then gave up trying. A few months later, his blood sugar soared, and he spent five days in the ICU. Taxpayers covered most of the $41,000 bill. It all could have been avoided by easier access to care, said the nurse practitioner who treated him.

Contact staff writer Michael Vitez

at 215-854-5639 or

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