SMITH COUNTY INDIGENT HEALTH CARE

TYLER TEXAS AGREES TO DO SURGERY AND ABSORB COSTS

Debra Mckeever/ Smith County Indigent Health Care
East Texas Medical Center Regional Healthcare System
801 Clinic Drive
PO Box 7000
Tyler, Texas 75711-7000
(903-535-6564)

Medical Treatment & Surgery at Tyler: May 20-30, 1997
Category: Temporary Approval for Surgery: Housing Approved 7 days: Local Salvation Army staff suggest no problems with housing for surgery and operation, gives go for medical procedures.

Category: Approval for County Health Care: County Medicade Authorized: Smith County Indigent Health Care Debra McKeever (903-535-6564) gives me statement I can recieve surgery.

Category: Dr. Removes 2 Tumors: Dr. Donal W. Steph (Surgeon) (903-597-1132) Dr. Steph does surgery on Thursday, May 21,1997 and signs a statement that he removed a "malignant melanoma" from neck. Next removes tumor removes unknown type of tumor in capsule from groin which appears to have a independent blood supply on the outside of the tumor with no serious problems in about 10 minutes. Dr. provides statement I am unable to work/recover for 2 weeks. Referral to Dr. Fisher for bowel problems.

Category: Sudden Appearance of Cancer on Hands: Appearance of Cancer/Treatment on Hand: Shortly after surgery I have 9 sores open up on my left hand and about 5 on right hand and begin treatment with the good old stand by peroxide.

Category: Lab Results from Surgery: Test Results Good: May 29,1997 Dr. Steph states very little evidence of cancer exist in tumor he cut out of neck (except 4 inch long scar) which he state would have been much smaller if he knew this earlier, oh well. Dr. Steph states other tumor has a name I won't attempt to repeat which he explained was found to be benign and of unknown orgin and not likely to represent a future threat. Dr. removed stiches and explained we had very good results and reports which is fine by me and basis of my report back to the Smith County Indigent Health Care.

Category: Prognosis New Cancer: More Cancer? I showed Dr. Steph the open sores on the back of both hands and explained they were not going away from peroxide treatment as most sores historically do. He state it was probally just some more Cancer and not to worry about it. Literature in the doctor office from American Cancer Society has graphic pictures of such tumors and explains they are not Melanomas and not generally prone to spread.

Category: New Sites of Cancers: Locations and Sites of Possible Cancers: 9 Open holes in back of left hand which are not healing. 4 Open holes in back of right hand which are not healing and a lot of small ones up right arm which were very small and have appeared to have dried up and disappeared. Open hole on left cheek which refuses to close and has not closed since it appeared in Arizona in Februrary, 1997. Several long standing holes or lesions on right buttock which bleed and crust over and are not responding to peroxide treatments.

Explanation By Dr. Steph. May, 1997
Category: Client questions concerning medical results: Dr. Steph explains the tumor excised from my groin is a large infected cyst (benign) resulting from infective process.... At conclusion of surgery Dr. Steph cut open tumor for me to examine at my request. Tumor tissue appeared to be pink, healthy, and encapsulated with no sign of pus or other infection and has an attached blood supply. Unresolved question: How does "infection" appear healthy, pink, solid with it's own blood supply?

Dr. Mark Fleisher, Tyler Medical Clinic
(903-592-2611) Category: GI Doctor does intake:
Dr. Fleisher: interviews me on May 29,1997 and asks for an explanation for health problems associated with my bowels which predate 1964. Previous doctors suggested Illitis and Collitis, spastic colon, gastritis, mucus, and removed benign polyp from rectal examination.

Category: Dr.takes medical history:
Dr. Fleisher states that terms illitis and collitis and spastic colon are contradictory and I explain I don't understand medical terminology and am repeating what I was told. What it means I haven't got a clue. Current problem involves not having regular bowel movements which may not occur for several days at a time and are often followed by sever pain and very hot liquid liquid diarrhoea which often runs for a day or so. Fecal matter is much smaller in size than and shape than was previous normal a year or so ago. Sometimes passings are black and tarry. Request for medical records from Air Force are being sent out and may or may not be successful because Homestead AFB Hospital and base was destroyied by Hurricane Andrew in 1992.

Category: 2nd Medical Opinion on Cancer on Hands:
Dr. Fleisher: looks at lesions on hands and suggest I am whipping a dead horse to continue to put peroxide on sores or lesions as they might be cancerous.

Category: Intial Dr. Opinon/Treatment: Dr. Fleisher: suggested that not having a bowel movement for 3 days and having cycle of severe gastritis or hot diarrhoea is not normal. Dr. Fleisher does not know why pickles, mustard, or vinegar products would be beneficial to my condition ( I don't have a clue either) however suggest it can't hurt. Dr. Fleisher: schedules bowel examination procedure for next Tuesday which involves putting probe into rectum to see what is going on in there and see what needs to be done. Dr. Fleisher prescribes 150 Librax Capsule as possible treatment for problems which the pharmacy has substituted with a Clindex Capsules?

Category: Dr schedules medical exam: Dr. Fleisher sents note to Salvation Army for me to show up for this procedure which I deliver and explains I need to have someone drive me home afterwards because of use of a pain killer or whatever.

Category: Problem in schedule medical exam: Several problems exist which make treatment not pratical at this time. I have had the colon exam before and do not know why Dr. insist I be unconscious during the procedure. Am unable to purchase special soda for colon exam. There are no circumstances where I will provide free labor for the Salvation Army.

Category: Salvation Army demands "volunteer labor": May 28,1997 Lodge Manager Rusty states he wants me to work as a "volunteer" for the Salvation Army beginning Friday, May 30th, 1997 and look for work which is part of existing program. Salvation Army staff and guest express reservations about continuation of medical treatment with next Doctor. The type of work being requested by the Salvation Army is working in their warehouse moving refrigerators, stoves,hide abeds.... and other heavy objects.

Category: Unresolved health question precludes employment: How is a person having upwards of 25 bowel movements a day from medication Clindex supposed to work for anyone.

COUNTY INDIGENT HEALTH CARE PROGRAM

TO: Christopher Alan Walters Date: 5-21-97
% Salvation Army SMITH COUNTY
717 N Spring Street Case Number: 9705537
Tyler, Texas 75702 DOB: 10-17-50
Note: SSI/SSDI Appellant-No NOTICE OF ELIGIBILITY

Your application for County Indigent Health Care Program Benefits is approved. You are eligible for medical services beginning 5-20-97

Please show this letter each time you request medical services:

The only pharmacy you can use is Craig Pharmacy, 1406 S Fleishel, Tyler Text. Your case review date is no later than: 10-31-97 This program is not responsible for medical expenses incurred after the review date, unless eligility is re-established when your case is reviewed. Note: Medical Claims received more than 95 days (1) after the Indigent Health Care Certification date; or, (2) more than 95 days after the services are rendered are not eligible for payment by this program.
By/ Debra McKeever Smith County Indigent Medical Health Care Officer

Your ResponsibilitiesYou must notify this office within 14 days of any changes in your situation, such as changes in your income, property, household members, child care expense, address, SSI, SSI Application, or SSI, SSD decision. If a change occures that makes you ineligible, and you fail to report the change as required, you may be held responsible for payment of any medical service you recieve after you become ineligible or you may be subject to prosecution under Texas Penal Code***Should you apply for SSI,SSD, provide a reciept.

Mail Medical Claims Too: Indigent Health Care

Attn: Bookkeeper PO Box 7000 Tyler, Texas 75711-7000

(903-531-8361) SMITH COUNTY INDIGENT HEALTH CARE PROGRAM 801 Clinic Drive (The Pavilion) Tyler, TX 75711-7000

This form is to be completed by Head of Household. All Blanks must be completed.
Note: If you live alone, please ask a friend to complete this form.

Clients Name: Christopher A Walters Case: 9705537

1. Give names of all persons in household: This is a homeless shelter client count changes.

2. Give address where these people live, not PO Box.

c/o Salvation Army Lodge
717 N Spring
Tyler, Texas 75702

3. How Long have you known the client? Period of some years off and on.

4. Give relationship to client: Provide shelter

5. Do you give the client money? If yes explain how much, how often, and the reason. No

6. What do you provide for the client? Housing, food, personal items, explain below: Housing, food, hygiene items, shelter

7. To your knowledge, has the client worked anywhere (Includes Odd Jobs) in the past fourt months? No

Signed: Rusty Matheny Dated: 5/23/97
Phone (903-592-4361

INC REV 04-97

SMITH COUNTY INDIGENT HEALTH CARE PROGRAM

PO Box 7000
Tyler, Texas 75711-7000
SCIHCP APPLICATION/Case No 9705537
Case Name:
Christopher A. Walters PHYSICIAN'S STATEMENT

The patient named above has applied for SCIHCP. State regulations require that all persons between the ages of 18-50 years who recieve SCIHCP be registered with the Texas Employment Commission unless they are physically or mentally incapable of holding gainful employment.

The applicant claims a disability which precludes gainful employment. Any financial charges which result from the completion of this form or from any exam or testing required in the completion of this form are the responsibility of the applicant. Your cooperation in completing the following questions will be appreciated. After completion, please give this letter to the patient who will bring it to us or mail it in the attached envelope. SMITH COUNTY INDIGENT HEALTH CARE PROGRAM

By: Debra McKeever 5-21-97

Medical information on this report is confidential, becomes the property of, and may be used within the discretion of the SCHICP or shared with other governmetnal agencies to determine eligility for benefits or rehabilitation services. This medical report may become available to the household or the household's represenative for examination up request

*********************************************************************

DIAGNOSIS:

Post Op excision of malignant malanoma neck

Post op excision tumor supra public area

To what extent is the patient employable
Full time, but restricted too Checked no heavy work

PROGNOSIS:

Good

How long will patient be disabled from work? (approximate number of months, if not permanent.... 2 weeks

Physicial Signature Donal W. Steph Date 5/23/97