Discounted surgeries bring the uninsured new hope in California

BAKERSFIELD, Calif. — As a young surgeon, Dr. Jorge A. Enriquez watched his peers fly across the ocean to do charity work in far-flung places. But he was struck by the needs of his own community here amid the agricultural lands of the Central Valley.

Many workers have seasonal, low-wage jobs without health insurance.

So Enriquez set out to find them low-cost medical care. He rallied a network of doctors willing to provide surgeries for free, or at a cut rate. In the past four years, Cirugia sin Fronteras — translated as Surgery Without Borders — has treated about 1,200 patients.

Now he’s setting up a nonprofit foundation to raise funds to expand the network.

“When you’re eating your delicious lettuce, most likely someone without insurance cut it for you,” Enriquez said. Emergency rooms will treat emergencies. But for debilitating ailments that fall short of being life-threatening, the uninsured have few options. “You’re not admitted until you’re close to dying, which is a paradox,” Enriquez said.

Cirugia sin Fronteras’s patients include Salvador Montelongo, a farm worker in Arvin, Calif., a heavily Latino community outside Bakersfield. When Montelongo was 8, his mother burned his hands on a hot stove as punishment, fusing the fingers. As an adult, he figured out a way to manipulate a pruner using only his wrists, enabling him to earn a living in the fields.

Yet his hope for a surgery that might repair his hands and perhaps one day enable him to become a chef seemed chimerical at best, the estimated five-figure cost an obstacle that “closed everything for me,” he said.

That was until a friend heard a public service announcement on Spanish-language radio for Cirugia sin Fronteras. Montelongo underwent hand surgery last year, and is now working as a chef at a small Mexican restaurant in Arvin. He is finally able to perfect his knife skills. More profoundly, it has improved his ability to comfort his daughter. “I used to hold her with my wrists,” he said. “Now, I hold her better.”

A life apart

Enriquez, a general surgeon, was born in Mexico. After medical residencies at the University of California, San Diego and at the Kern Medical Center in Bakersfield, he decided to stay in Kern County, where roughly half the residents are Latino and approximately one-fifth of families live at or below the federal poverty level.

One patient, in particular, pushed Enriquez to launch his surgery network. Alejandro Barreras came to his office with a benign tumor larger than a grapefruit on the back of his neck. The tumor marred Barreras’s appearance, made it hard for him to find work, and ruled his life: the only place he could sleep was on a recliner into which he had cut a hole to accommodate it. He contemplated suicide.

Friends of Barreras’s eventually found Enriquez and elicited donations from well-wishers through a radio station that publicized the case. Surgeons removed the growth, and Barreras is tumor-free today.

“This poor man was living a life most Americans don’t come across,” Enriquez said. “They’re the ones that nobody wants to see.”

Since then, Enriquez has built his small project into a network of 28 participating surgeons, four major hospitals, and two radiology and pathology laboratories. Enriquez’s collaborators include OB/GYNs, gastroenterologists, endocrinologists, a gynecological oncologist, and a specialist in plastic, reconstructive, and hand surgery.

The organization specializes in uninsured patients of productive working age. Patients are asked to pay a small amount, but the rest of the cost is made up by doctors’ donated time and discounted hospital rates available to patients with limited financial means.

A surgery for gallstones or a large hernia that might typically cost $16,000 to $21,000 might be performed for $3,600, for example. “We go to a number that the patient is able to pay,” Enriquez said.

The program also functions as a clearinghouse, helping people who may not speak English navigate the health care bureaucracy. Undocumented immigrants are particularly in need of the group’s services.

The provisions of the Affordable Care Act do not extend to noncitizens — a particular challenge in California, where an estimated 3 million people remain uninsured, about half of them unauthorized immigrants. (Under a new state law, however, children in California who are undocumented will receive health coverage as of next month.)

Nonprofit hospitals are required to offer discounts, free care, or other financial assistance to certain disadvantaged patients, and a separate California law limits the amount emergency room physicians and anesthesiologists can charge poor uninsured patients.

But many undocumented immigrants with chronic conditions still fall through the cracks of “a patchwork of services for the uninsured,” said Amanda Puck, a supervising staff attorney at Greater Bakersfield Legal Assistance.

‘My life is going to change’

On a recent morning, Rosa Manriquez, 32, rang the doorbell of Cirugia sin Fronteras’s homey offices, hands chilly with nervousness, flanked by her husband and two children. She was there for a presurgical meeting with Enriquez and Dr. Leonard Perez, who had diagnosed her with an umbilical hernia and numerous cysts.

“I have a lot of emotions,” she said. “I think my life is going to change 100 percent.”

Manriquez, a housecleaner who lives in Las Vegas, had been having medical issues for eight years, since a botched tubal ligation. “We were not doing well financially, so I had to go back to work and did not have enough time to take care of myself,” she explained. She has periodically experienced hemorrhaging.

In Nevada, Manriquez was told that presurgery tests alone would cost nearly $5,000 and a hysterectomy $90,000. “I got depressed and just went into a hole,” she recalled. “I thought, ‘I’m just gonna die soon.’”

She flirted with the idea of returning to Mexico, where health care is cheaper, but decided it was too risky and would disrupt her children’s education. The family struggled as her health deteriorated. Then she met staffers from Cirugia sin Fronteras at a health fair in Las Vegas.

Finally able to contemplate the surgery she needed, Manriquez spent six months baking and selling cheesecakes, flans, and Jell-O dishes to raise $4,000 to pay the reduced fee. She raised an additional $900 through the website gofundme.com.

The conditions requiring surgery through Cirugia sin Fronteras are often occupation-related, such as hernias and prolapsed bladders from heavy lifting.

While its surgeons can treat breast and uterine cancer, certain operations like cardiac or brain surgery are beyond its scope. “We do our best to keep the common man healthy and productive and preserve the family economy,” Enriquez said. “We want to do surgeries we can resolve.” If a condition is beyond their expertise, patients are referred to an outside specialist. Now, the CSF Medical Nonprofit Foundation is raising funds to fully cover the costs of surgery for the poorest patients, and to expand its network of specialists beyond Bakersfield.

“When people ask why I do it, the simple answer is, I want to,” he said. “Each individual in our community, whether he is a cook, a construction worker, or a field worker, is a spoke in the wheels of a complicated clock. By helping them, we help ourselves.”