(Interview 1/2012. Oil on canvas, 40 ins. x 30 ins.)
Update 2021
Here is what Scott shared when I reached out.
"I'm not sure there is much to add to my story regarding the accident these past years. Life goes on. My foot has been as healed as it can be, there is the occasional phantom pain. And I have a weird callus over where the worst wound was, that gets so hard and pointed it will rip socks and damage the inside of shoes. But life is good, the whole ordeal made me appreciate the little things and chase happiness over career or vain pursuits. Even through COVID and the struggles that caused, I must say in the end I have been much more fortunate than how the pandemic affected many people."
I interviewed Scott in 2012. If I had finished this painting and had had enough time for this painting to dry, I would have stood with it in front of the Supreme Court in Washington DC to make the point that young people NEED health insurance. (The paints can set up in a couple of weeks but not enough for me to be able to toss the painting around like a sack of onions which I did when I hauled those portraits to and from the Union Station parking garage.
If I could I would have taken this portrait to Washington DC. So many opposed to healthcare reform said that young people do not need health insurance. The young are strong and healthy, they say. I wish I knew then what I know now after painting so many portrait stories of people under 40.
Young people need health insurance.
Artist Note (2013)
This experienced winter hiker had an accident on a mountain. When he finally made it to the hospital, his right foot was a shriveled, dark blue-purple, frostbitten mess.
“This was the hardest day I ever had to live through. Without insurance? "I would have been dead.”
Scott is an estimator. He's good at details and numbers. He examined all the paperwork. The emergency room visit 7 hours from home, and subsequent admission to the hospital cost $22,000. “I was floored,” he said. Scott wondered where he would be without health insurance to pay his medical bills. “Two nights, no helicopter, no ambulance, one pain killer”-- $22,000.
In 2013, Scott finds himself unemployed and looking into how COBRA insurance works. The COBRA law guarantees employees the right to stay on employers’ group health plans for up to 18 months after leaving a job. However, the former employee not the employer usually pays the full cost of the premium.
(From a 1/2012 interview)
Estimator, Insured with Brief Period of Being Uninsured, Age 27
Scott's employer pays 100% of his health insurance premium. Scott said, "This was the hardest day I ever had to live through. Without insurance, I would have been dead.” Scott never used his insurance before the accident.
THE STORY
Scott, an experienced winter hiker, took longer to get off the mountain than anticipated. His training enabled him to spend the night outdoors in satisfactory conditions.
At sunset Scott started bushwhacking his way back to the main trail. Then the weather turned. The lithium batteries in his headlamp lasted longer in the cold than regular alkaline batteries but the LEDs eventually iced over and his light dimmed.
With no strong light in bad weather conditions, Scott skirted a drainage path to make his way out. As he was circling a boulder, he fell through the snow into water.
Panic set in. Adrenaline pumped. Scott threw off his trek poles. He was in frigid water up to his thighs. The surrounding snow around the newly-made hole was over his head.
Scott stepped deeper into the icy water, feeling around with his foot until he felt a rock. He pushed off the rock, shimmied out of the hole by pressing his back against one side and lodging his feet on the other side in order to hoist himself out of the hole. Once out of the hole, Scott kept moving to prevent his waterlogged feet from freezing.
Total darkness. The light from his head lamp was faint. Scott kept moving. By morning, he realized he had missed the turn, the exit to main trail. Exhausted, Scott put on every piece of warm clothing he had and lit a fire. The fire was weak. The larger pieces of wood were wet. Scott looked around for white cedar which burns easily even in wet conditions. He took off his boots, warmed his feet and dried his socks.
Scott slept and awoke in the middle of the night. Cold. He started another fire.
The left boot would not go back on his foot. The boot felt frozen. Scott wrapped the foot in plastic, a foil survival blanket ,and the ground cloth from the tent. He then strapped a snowshoe on the bootless foot, and continued his trek to find his way off the mountain.
In daylight Scott saw that he passed over his own footprints. He knew something wasn't right. He tried to get to the top of a hill to get an overview, but the forest was too dense for him to see anything. He could not get his bearings. Anger was setting in. Daylight started to fade.
His compass said he was heading northwest. He knew he was at the base of a mountain. He would bushwhack his way out although his trek could not be a straight line because of the mountainous terrain. Darkness fell and he missed the trail he was trying to find. There was a recent snow and no trail markers or footprints to guide him. He knew if he headed north, he would find a road. Instead he came upon a trail with a marker. He knew at once he would be able to find his way out.
Long past midnight, with the way off the mountain ahead of him, Scott sat on a log for 10-20 minutes until he felt too cold. He would fall asleep, shiver, wake up then move. Scott never thought he would die, and he was unaware of the frostbite.
So very tired from having been up for 24 hours. Scott saw the sun rise. He saw other footprints on the trail and the main road ahead of him. He left his backpack on the side of the road. He started the walk to his car two miles away. A ranger in a truck stopped to ask his name. A search party was organized. They had been preparing to go look for him. An EMT wrapped his feet in a sleeping bag and took him to the hospital.
Scott's insurance card was in his wallet in the car which was parked in a lot on the trail. Somebody went to get his wallet. Scott does not know who. Doctors at the local hospital ordered bloodwork. They soaked the left foot, the bootless foot, in warm water. Staff went through two pairs of sheers trying to cut off the boot on the subject's right foot.The right foot was a shriveled, dark blue-purple. The bootless foot wrapped in a survival blanket looked much better than the foot wearing the boot.
Fear set in. Even with the hot water baths, there were still frozen bits inside the booted foot. Scott writhed in pain. A surgeon saw him the next day and said he could not make the call to amputate because of the swelling. Scott would have to wait a few weeks for a determination. He was 7 hours from home. A friend picked him up to take him home. Many months of treatments would follow.
How it started...
THE TREATMENT
Scott got a referral from his primary care doctor to go to a wound treatment center. The vascular surgeon told him he had frostbite, peripheral edema and gangrene on his right foot.
Scott had significant frostbite in both feet. The bootless foot healed within months. Scott had use of it as though nothing had happened. The booted right food was in far worse condition. The frozen boot restricted circulation. Doctors ordered x-rays and an EKG to see if he was healthy enough to get treatments in the hyperbaric chamber where he would be breathing 100 percent oxygen at elevated pressure to accelerate healing.
Scott got hyperbaric chamber treatments every day totaling 40 treatments. Each treatment lasted 2 hours. Some necrotic tissue remained on the foot. Scott had follow-up appointments with the doctor every week.
The foot took a turn and the tissue became mummified. The toe was “hard, shrunken and shriveled.” Surgery was required. The surgeon had to amputate more than expected to find healthy tissue. The doctor amputated the toe from the nail bed forward.
Scott noticed that the paperwork said “amputation” but the wristband said “partial amputation.” Scott had the doctor pulled from the ER to correct the paperwork to avoid any confusion about how much to amputate.
Scott felt the healing had stalled 5-6 weeks after surgery. He felt pain when he rode his bike. Red flag.Scott elevated his foot for a day. The pain was equal to what he felt when the foot was frostbitten. A bubble formed on the foot. Infection set in. His medical providers x-rayed the foot and prescribed an antibiotic.
The x-rays were taken at the hospital. Scott insisted that he could not wait the standard 2 days for the results. He was very proactive in getting the x-rays to the wound center. Intravenous antibiotics would not work. The foot was too far gone. The portion of the toe that remained had severe osteomyelitis. The lymph node in the leg was swollen.
Scott drove himself to the hospital. He was frightened. “Would they even be able to operate on me?” Had he eaten or drunk anything? By sheer luck, he hadn’t. The surgeon dropped everything to operate before the bone infection spread further.
“This was the hardest day I ever had to live through. Without insurance? "I would have been dead.”
In recovery, no one could tell him anything. “How much did they take?” He tried to squeeze the bandage around his foot to find out. The doctor prescribed 3 different intravenous antibiotics and a blood thinner. He spent 2 days in the hospital.
The doctor gave Scott a referral for home care twice a week. Visiting nurses changed bandages, took vital signs and asked questions. Caregovers closely monitored his progress.
THE INSURANCE
The local hospital near the mountain where the accident happened was in the Scott 's insurance network. They charged him a $100 co-pay for the visit. It appears the surgeon was out-of-network and the subject was responsible for more out-of-pocket costs. He had no way of knowing this when he was being treated in the emergency room for frostbite.
Scott says, "The bill was for 'professional services rendered' but, really, all he did was come in and talk to me for 10 minutes or so and tell me to see my personal physician when I got home to find out what steps to take toward treatment/recovery.
"Naturally I am reluctant to pay such an outrageous bill that is questionable at best. But eventually I guess I'll have to scrape the money together. I don't have any documentation to refute it. They wouldn't change the billing because they have a note from him explaining what to bill for. They are sending me a release to sign so I can get a copy of the note."
Scott followed up with this statement, "I was quite impressed that when I contacted my insurance company to try to get some insight, they actually took the reins and fought this for me so I did not have to pay out of pocket for the non-network surgeon."
The emergency room visit and subsequent admission to the hospital cost $22,000. Scott was floored. He wondered where he would be without insurance. “2 nights, no helicopter, no ambulance, 1 pain killer.”
Scott never paid out-of-pocket for hyperbaric chamber treatments. One time, however, a treatment was miscoded. "Initially they (billing office) told me it was an error on their end. Now they are sending me letters that I am overdue." The billing office told Scott they “couldn’t change it.”
The bills kept coming for this one miscoded treatment. "I can't imagine how stressful these types of issues are for people who are under- or uninsured. "
The provider send Scott a notice. The unpaid bill would go to collections. Scott put his reply in writing. "I explained the situation, and that I had called several times. I never heard anything from their office again and no collection company contacted me, so they must have finally corrected the issue."
Scott thought his insurance covered his wound supplies. Reps gave him bad information. The bills started coming. Insurance covered 50% of the costs. Scott continues to pay down the bill for the medical supplies. "I did not discontinue supplies, however, I switched to another medical supply company early on with much better customer service that allowed me to adjust my orders prior to shipping to help manage what I was getting billed for - i.e. reduce quantities or cancel certain items."
Scott paid a $100 co-pay for the first surgery as an out-patient for the partial toe amputation. His co-pay for the hospital stay and second surgery was $400.
After the second surgery, his doctor recommended a wound vac, a bandage designed to accelerate healing. It cost $140/day. The insurance company would not pay for it. They said Scott's condition did not qualify him to have it. The two-week recommended use would have cost about $2,000 which the Scott could not afford. He returned the device.
Scott considered paying for additional hyperbaric chamber treatments after the insurance coverage ran out. But he could not manage the $2,000 price tag per treatment.
SCOTT'S STATEMENT (2013)
Healing has not actually fully ended.
The nurses at the wound care center scoffed at my unhappiness about having to wait another 3 months for healing (an estimate on my part based on the preceding months of healing). They felt that was exaggerated, however, today it is still not healed.
The surgeon discharged me from making my follow-up visits in June of 2012 feeling that the foot was essentially healed, although naturally I could be back in the unlikely event a problem came up. The doctor believed the slow healing was due to damage to blood vessels from the frostbite.
"In December 2012 I got fed up with the off and on condition of my foot and got a referral from my GP to see a new surgeon at the U of Penn wound center to get a fresh view on things. I'm actually scheduled for a follow up visit in January. I was very impressed with them. They seemed to have taken my concern over the delayed healing seriously and showed a genuine interest which is the main reason I chose a university hospital for a second opinion.
During my initial visit two nurses came in to look me over and ask questions and draw on their experience to spitball possibilities off each other. And then they left to send in the doctor with another experienced nurse. They seem confident of the possible causes, and naturally the methods to address those causes once we narrow down which one.