When Dale Smith of Barbourville, Ky., learned he needed a hernia operation, he worried because he had no health insurance. He didn't know how much the operation would cost, but he knew it would be more than he could afford.
Then he was told about Surgery on Sunday in Lexington, Ky., which is about two hours from his home. The free outpatient surgical program is for people whose incomes fall below the federal poverty line, and who cannot afford private health insurance but do not qualify for Medicaid.
Patients are referred from health care organizations and receive badly needed surgeries, including gallbladder, cataract and orthopedic procedures, as well as postoperative care.
"The clinic where they found the hernia signed me up for Surgery on Sunday," explained Smith, 51, who at the time worked as a manager at an auto parts shop. "All the nurses, the anesthesiologist, the surgeon — everyone — took wonderful care of me. I knew I was in great hands from the minute I walked in and started being prepped by the nurse. She made me feel so comfortable and relaxed.
"That people would donate their time like that is amazing," he added. "No way could I afford the surgery, yet they took me in with open arms."
Seeds of hope
Surgery on Sunday is the brainchild of Dr. Andrew Moore, 63, a Lexington-based plastic surgeon who worked for years to secure a surgery program to serve the working poor who "fell through the cracks."
Surgery on Sunday started in September 2005 at the Lexington Surgery Center with $145,000 in seed money from Englewood, Colo.-based Catholic Health Initiatives. Since its inception, the program has served more than 4,300 low-income patients. The surgeries take place monthly, typically on the third Sunday.
"We triage based on urgency and the surgeons volunteering," explained Laura Ebert, executive director of Surgery on Sunday. "We never promise patients when they will be on the schedule, but we do ask them to let us know if they have a change in their condition."
High demand
Ebert explained that because of the great demand, Surgery on Sunday worked hard to expand the program to other hospitals in Lexington. Saint Joseph Hospital was a natural partner. It is part of Saint Joseph Health System, which became a majority general partner in the surgery center in 2010. Saint Joseph Health System in turn is part of KentuckyOne Health, a new system that is majority owned by CHI.
Saint Joseph Hospital became a Surgery on Sunday provider in March 2011, performing Sunday surgeries once every quarter. Central Baptist Hospital is joining the program and may be ready to hold its first volunteer surgery event in January, Ebert said. Program administrators hope the University of Kentucky hospitals will donate their facilities too. The addition of host hospitals to the rotation with Saint Joseph Hospital allows specialty surgeries to be scheduled in addition to the general surgeries at the surgery center.
"The surgical center isn't good at orthopedics, neurosurgery and ob-gyn, so now we can do those surgeries at St. Joe's and hopefully the other hospitals," said Moore.
Another benefit to more hospitals in the mix: the waiting list will decrease. "When we started the program, it was about 1,500," Ebert said. "Now, it's about 700."
Smith, for example, underwent hernia surgery in May 2010, eight months after he went on the waiting list.
On any given surgery Sunday at the center, Moore said roughly 70 people volunteer, including nine to 11 surgeons. "Our biggest problem is that we sometimes have too many volunteers," he said.
Day's work
Patients begin arriving around 6:30 a.m., surgeries begin at 7:30, and the intent is to have all operating rooms cleared by noon. "That said," said Ebert, "we have gone as late as 4 or 5 p.m." She explained that anywhere between 20 and 40 patients are served, depending on the procedures.
"If it is mainly gastrointestinal, we can do 35 to 40," she said, adding, "We have the best of the best performing these surgeries. People are here who want to do this. The chief of trauma at the University of Kentucky will volunteer and do all the gallbladders and hernias. These are surgeons at the top of their field."
Pain of poverty
Cynthia Frazer can vouch for that. A registered nurse for roughly 30 years, Frazer, 52, teaches nursing at Eastern Kentucky University in Richmond, and has been volunteering monthly with Surgery on Sunday for about three years.
Frazer tells of several patients who felt they had no choice but to neglect their health — and ultimately surgery — because they had no insurance. One gallbladder patient waited so long before seeking help that what should have been a relatively simple operation became much more complicated because of all the scar tissue from years of inflammation, Frazer explained. Luckily, she added, the surgeon was an expert and able to complete the surgery without complications.
"So many of our patients are employed but can't afford basic health care, or anything as expensive as surgery," said Frazer. "Some have been living with chronic pain for some time and their conditions often interfere with their ability to work. After surgery, they are so relieved and just so grateful."
High-value giving
The nonprofit Surgery on Sunday receives funding from United Way. The Sisters of Charity of Nazareth, Ky., donated $25,000 to the program last year. Other funders include the Samaritan Foundation, Fayette County Medical Society, Rotary Club of Lexington and the Keeneland Foundation.
In addition to Ebert, Surgery on Sunday employs a coordinator and a part-time assistant on an annual budget of $150,000. "We are now serving about 1,000 patients a year," Ebert said. "You can't get into a surgeon's office for less than $150, let alone be operated for that."
Moore said he dreams of Surgery on Sunday spreading across the country. He has developed a template to share with other communities and has been featured on CNN, in People, which named him one of the magazine's "Heroes Among Us," and on "ABC World News with Diane Sawyer."
"The biggest hindrance (to expansion) has been insurance," said Ebert. "The state of Kentucky is only one of two states, the other being New York, with medical malpractice insurance that covers free clinics." Moore added that Surgery on Sunday pays $7,000 a year, which covers everyone who volunteers, and thankfully, there has never been a malpractice claim. "Ideally, what we want is for the federal government to cover the insurance so that this program can go nationwide, and we're gearing up" to press for that.