By JUDITH EVANS
Photo by KAREN ELSHOUT
Throughout the hot summer of 2012, Kimberly Smothers worked 50 to 60 hours a week in an air conditioner factory. She knew she had a lump in her breast but couldn't find the time to have it checked.
Then the weather cooled, the demand for air conditioners fell and Smothers was laid off. Five months after she noticed the lump, she went to a doctor in Arkansas, just across the state line from her home in tiny Neelyville, Mo.
Smothers had no job, no medical insurance, $200 a week in unemployment compensation and breast cancer. Missouri refused to pay for her treatment because she had been diagnosed out of state.
A health clinic employee told her about Gateway to Hope, a private, nonprofit medical charity that connects women in need of breast cancer care with service providers willing to donate cancer surgery, chemotherapy, radiation therapy and reconstructive surgery. Gateway to Hope patients have been diagnosed with breast cancer or are genetically at high risk for developing breast cancer, are uninsured or underinsured and make less than 350 percent of the federal poverty guidelines (in 2013, $54,285 for a family of two and $82,425 for a family of four). Cyndi Stotler, one of program's three nurse managers, said Gateway to Hope also assists with prescription medications for long-term hormone therapy and with follow-up care.
Mercy and SSM Health Care are among the providers offering care at no cost through Gateway to Hope. Although patients come from all over Missouri and from St. Louis suburbs in southern Illinois, the partner providers are clustered in the St. Louis area, where the charity was founded in 2005 by Dr. David A. Caplin, a reconstructive surgeon, and Dr. Marlys E. Schuh, a surgical oncologist.
Getting the word out
Stotler said many patients learn about Gateway to Hope from physicians, social workers, churches, social networks or a web search. "Most of the mammogram teams know we exist," said Stotler. "Our outreach coordinator makes contacts in rural communities."
Smothers is one of about 390 patients in the Gateway to Hope program. With few exceptions, the patients have received treatments at no cost to them. Sixty new patients have been added since the start of the year. Because each patient's medical and financial circumstances differ, nurse managers write individualized service plans for each client, matching needs with the services pledged by hospitals, outpatient treatment centers and cancer specialists, and helping with insurance and financial issues. "If we can get them onto Medicaid, we do that," the program's Executive Director Cindy Frank said. "We do whatever we need to do to get them care." (The Gateway to Hope nurses do not provide direct patient care.)
Thelma's gift
Gateway to Hope's Thelma's Gift fund covers non-medical needs such as rent, mortgages, utility bills and gasoline. The fund can pay COBRA premiums so that clients who lose a job or get divorced during treatment can keep their insurance, and, by extension, their doctors and care team. Last year, that fund provided more than $90,000 worth of assistance. It began with a memorial gift and is maintained with philanthropic contributions and grant money. Grants, gifts and fundraising events fund the organization's $750,000 annual operating budget, Frank said.
A patient's challenge
Smothers' oncologist, Dr. Ka-vitha V. Kosuri, is part of the Mercy system. Smothers underwent chemotherapy from October through February, followed by surgery in March. Then, during a course of breast radiation, she developed back pain. The cancer had metastasized to her spine. As of mid-May, she'd had 33 radiation treatments on her breast and 20 treatments on her spine at the Mercy Clinic St. Louis Cancer and Breast Institute in suburban St. Louis.
The 48-year-old Smothers hasn't been able to work since she began chemotherapy. In February, she learned that she was eligible for health insurance through Medicaid. She stays with her sister in St. Louis while she undergoes radiation five days a week, and she returns to Neelyville on the weekends. The Thelma's Gift fund pays for gasoline.
"I'm not looking for a handout," she said. "I've worked all my life. I've got a 14-year-old daughter I'm trying to raise by myself."
All clear
When Robin Bailey was diagnosed with breast cancer in December 2011, she had just started a new job. Except for temp work, she had been unemployed for 14 months. "Because I had been out of work, I just picked a basic insurance" with limited coverage, she said.
Doctors told her she needed a lumpectomy; then, because the tumor margins were not clear, a second resection. That was followed by a bilateral mastectomy and reconstructive surgeries. Bailey is now cancer-free "It's been a much longer haul than I thought," said Bailey, 42, who lives in St. Louis.
She had the first two surgeries before coming to Gateway to Hope; and, because of her financial circumstance, she received a deeply discounted bill from Mercy, Frank said. She added that Thelma's Fund covered Bailey's mortgage while Bailey paid off her medical bills. Once Bailey became a Gateway to Hope patient, the program used Mercy-donated services for her care.
"When I say it's a gift, that word's not big enough," Bailey said.
Ministry partners
Carol Murphy, manager of cancer support services at Mercy, said that Gateway to Hope helps women who otherwise may fall through the cracks. "Our mission is to provide excellent quality care for people who are in need, and certainly, we don't turn away any patients who come to us with a problem," she said.
Gateway to Hope has a partnership agreement with Mercy to donate comprehensive medical treatment for breast cancer patients needing surgery, chemo and radiation treatments.
SSM Health Care — St. Louis has donated services to Gateway to Hope's patients since 2007. Last year, it expanded the partnership agreement to five hospitals.
"Our special mission is providing service to people on the margins," said Gaspare Calvaruso, the executive in charge of oncology services for the network and the president of SSM St. Joseph Health Center in St. Charles, Mo.
Last year, SSM provided care valued at more than $70,000 to Gateway to Hope's clients. "We can pretty much provide them the full continuum of care," Calvaruso said.
The partnership agreement with Gateway to Hope covers six surgeries, one medical case and one radiation oncology case per year. "We have been asked to do an imaging study instead of one of the surgeries," said Sandy Cobb, director of breast care services for SSM's St. Louis network. "We work with them. We do have that flexibility, so we are able to offer other things."
National model
Caplin and Frank are working with the American Society of Plastic Surgeons to replicate Gateway to Hope in other cities.
"You need to find one person who is willing to be the catalyst, just to get it going the way we did," Caplin said. "We'll be able to save hundreds of lives, maybe thousands, in St. Louis. If we can replicate this in 10 cities, we could save tens of thousands."
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