It was supposed to save her life - make her life better. Instead, complications from the life-changing surgery are threatening the life of one local woman. Doctors could fix the problem - but the government told her "no". And she's not alone. In a KOMO 4 Problem Solvers' investigation, we uncover what's behind this government Catch-22.

"Do I die tomorrow? Do I die in a week? Do I die in a month?" For Lisa Young, dying from malnutrition, or even suicide seemed her only options. "There's days that I just don't feel good, I feel like I'm going to die." Young is tied to a feeding tube. Suffering from malnutrition. Afraid to leave her apartment. All because of the gastric bypass surgery that was supposed to give her a new life. "I did it more for health reasons, ironically enough."

Medicare Disability paid for Young's surgery, because she has a degenerative bone disease, and losing the weight would help. But after the surgery, Young can't eat two bites without throwing up. By April she was suffering severe malnutrition, so her doctor at St Clare hospital in Lakewood installed a feeding tube. He wouldn't talk about it on camera but told me that he cannot repair the surgery, or fix the painful hernia now bulging from her stomach. "The pain gets up high because everything pushes so hard, against my chest wall and up high," Young gestures to her stomach.

Young's doctor referred her to the University of Washington Medical Center. They are specialists in severe complications from gastric bypass. But they can't treat her either. Thanks to Medicare. "Without any warning," says the U.W.'s Chief of General Surgery Patchen Dellinger, "Medicare issued a rule saying that now they would cover gastric bypasses but in order to do it you had to go to a so-called Center of Excellence."

And U-W is not a Center of Excellence. The "only" one in the state? The 110-bed St. Francis hospital in Federal Way. And because she's on Medicare - St. Francis turned Young down. Young read aloud from the letter she received, "We are unable to assume her care at this time as a Medicare patient."

"It's an unbelievable situation." says U.W.'s Dr. Dellinger. That Medicare ruling forced the U.W. to cancel surgeries for three dozen patients. Dr. Dellinger even argued with Medicare and it's local administrator Noridian - to let them at least take care of people suffering complications. "It almost defies the imagination that we're prohibited from caring for the complications, on-going complications - but that's how it's being interpreted at this time."

Young called Medicare offices across the country trying to find help. We listened in to one conversation as she explains to the Medicare operator, "I had surgery done in December of '05." After explaining the situation, Young got the same answer she's been hearing all along, "so Medicare will not cover a service if it's not under a Center of Excellence?"

She then asked to speak to a supervisor and again explained, "I'm on a feeding tube, I'm sick all the time, I'm still on pain medication and I can't see anyone?" After the umpteenth phone call Young is worn out, "Well it gets frustrating, I mean you try to get help the only way you know how and you can't get it."

On this day, speaking to the Medicare operators, Young calls it a particularly bad day, one with a lot of pain and very little hope. She wonders, "is this the way I have to live the rest of my life?"

Young says she called Medicare time after time for help. Doctors - including specialists from the University of Washington argued with Medicare to let "them" treat patients like Young. Dr. Dellinger was also frustrated, "We were told it wasn't possible."

Young is beyond frustration, "You try and get help the only way you know how and you can't get it."

When KOMO 4 Problem Solvers started calling Medicare offices from Seattle to D.C. I got the same answer. No surgeries, not even for complications, unless they were performed at a Center of Excellence. Finally we turned to Medicare's local administrator - Noridian insurance in Kent. This is the company that makes the on-the-ground decisions to pay, or not to pay, for procedures in this region.

After weeks trading phone calls, we showed up at their Kent office. And they told us - call their Public Relations in North Dakota. We told them, "the patients that we've been speaking to don't have three more weeks to sit around and wait for an answer."

Finally, Noridian's local medical director, Dr. Bernice Hecker, agreed to see us. We showed her photographs of Lisa Young, told Dr. Hecker that Young had been living on a feeding tube for months. Dr. Hecker gave us a radically different answer than every other Medicare office. "If she needs a revision, if she has a complication, Medicare pays for the treatment of complications."

And Dr. Hecker insists Medicare would always have paid for Lisa's surgery where ever it's most appropriate. And she told us that had been their answer to any local institutions or Doctors who contacted them. When we questioned that, "I have to tell you that just doesn't jibe with what we're hearing from providers." Dr.Hecker's response? "Well you know what? It's not surprising, there's a lot going on and they need to call us."

But they did call - repeatedly. The U.W.'s Dr. Dellinger called. Lisa Young called. KOMO 4 News called. We asked Dr. Hecker, "why is it then that every provider we've spoken with has said they are told that they cannot do any revisions, corrections on complications of gastric bypass surgery?"

Her answer? "Perhaps because they haven't been reading what we have published." But in fact, Noridian Medicare didn't publish anything about paying for bypass complications, until "after" our interview.


Lisa Young was dumbfounded that the local Medicare office said she just needed to call. "I tried, I called and I called and I called," says Young, "and I did everything I could think to do, even prior to speaking with you - no offense but you were the last hope."

Finally - after months and months of waiting - Lisa Young will get her surgery. "That's wonderful, that's really wonderful." And she's convinced it wouldn't have happened unless her friend contacted KOMO 4 News. "Well I know one thing, I really appreciate all this because I know I'd have never gotten anywhere without this, without you."

Young is currently undergoing preliminary tests and procedures at the University of Washington, she expects to undergo corrective surgery soon.