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The Case for Prevention: $57 "Savings" Ends Up Costing $2 Million and — Nearly — a Life


Bart Clifford
For lack of a new $57 shower chair, Bart Clifford suffered an injury and a gangrene infection that put him in the hospital for months, required multiple surgeries and skin grafts, and ran up more than $2 million in medical costs.

For lack of a new $57 shower chair, Bart Clifford suffered an injury and a gangrene infection that put him in the hospital for months, required multiple surgeries and skin grafts, and ran up more than $2 million in medical costs.

Clifford's case is a dramatic example of how the patchwork system of uncoordinated health care can be "penny-wise and pound-foolish." It also shows how a prudent preventive approach could improve lives and save money by focusing more directly on a patient's primary care needs.

Clifford lost the use of his legs as a result of a shooting by police in a drug-related incident more than 25 years ago. The nerve damage contributed to the problems he had with a broken shower chair.

Shower chairs usually last two years, but Clifford's chair bent and cracked after 18 months. His application for a new one was rejected by his health plan, which covered replacement chairs only every two years.

Clifford continued to use his broken chair, which caused a cut in his groin. Because of his lack of sensation below the waist, Clifford did not realize the severity of the cut, which became infected. By the time he landed in the hospital, the infection was a life-threatening gangrene. He underwent several abdominal surgeries, a colostomy and skin grafts on his buttocks.

Clifford's primary care physician, Dr. Evan Saulino, tallied the medical costs of this preventable injury at $2.1 million.

"Basically, he was in bed for two years," Saulino says. "If he had gotten the $57 chair, he wouldn't have gotten the infection. He wouldn't have had all those surgeries and skin grafts. He wouldn't have a colostomy. And he wouldn't have run up over $2 million in medical bills."

Today Clifford, 54, lives independently in an apartment in Beaverton with his 1-year-old son. He is enrolled in the Oregon Health Plan and, as a disabled adult, receives Supplemental Security Income benefits.

Besides his spinal cord injury, Clifford has several chronic illnesses, including high blood pressure, congestive heart failure and abdominal pain. He has been treated for bladder cancer. Coordinated primary care allows him to keep those conditions under control.

"He's an extreme example," Saulino says, "but his story happens in a lot of little ways all the time."