Louie Sears is the walking wounded. He has a form of brittle bone disease, which means he can fracture a bone easily. He's had a bad hip since he was 7 years old.
He knows it's more expensive to go to the emergency room for health care, but he doesn't have a primary care doctor, which isn't unusual for Medicaid patients.
"When you have a toothache or a broken bone and you're in pain and you can't wait, you go to the emergency room," he said.
Sears, 36, said he went to the Carson Tahoe Regional Medical Center emergency room on May 7 after he fractured his arm while playing softball. He was referred to the Sierra Family Health Center, which then referred him to an orthopedist, a doctor who casts bones. He went to the office and was told the doctor didn't take Medicaid.
This case isn't unusual, said Deena McKenzie, former director of ambulatory and clinical services at the medical center. Depending on the injury, either an orthopedist comes to the hospital or the patient is referred to the physician's office.
"Generally people who have Medicaid, we will refer them to Sierra Family health," she said. "At that point it's the patient's responsibility to keep their appointment."
Sears returned to the hospital looking for medical care. Again he was referred to the Medicaid clinic, where he waited for several hours before giving up. He doesn't know where to go next.
He's still working as a carpenter in Reno despite his broken arm. Sears is supporting three children. His wife, Lisa Rodrigues, is a student at the Carson City Beauty Academy.
"I just put an Ace bandage on it because I can't afford not to work," Sears said. "It just helps keep my arm together."
Eight out of 10 of those who lack insurance nationally are in working families, according to the state Department of Health and Human Services. Uninsured workers tend to have jobs in the service industry with lower wages or work for small businesses.
Sears' employer doesn't have insurance coverage. Although he has hopes of being able to afford insurance himself one day, an insurance company may cringe at his health record.
Sears has been to the ER "several times" for broken bones. A dental office in Reno pulls his aching teeth.
"Medicaid only pays for teeth to be pulled, they won't have them fixed," he said.
Sears has 15 teeth left. The upper part of his mouth is all gum when he smiles.
"I'm about ready to file for bankruptcy for past doctors' bills," he said.
While working on a Skilsaw in 1998, Sears cut off three fingers on his left hand, two were put back on, minus the top section of his ring finger, which had to come off because of gangrene. That happened at work, so he was covered by workers' compensation.
Other mishaps weren't covered. He broke his collarbone and shoulder last year, which is when the family lost the house. He's broken his left leg twice and his right leg once in three places.
Medical misfortunes have struck his family. When 10-year-old Tierra was 18 months old she nearly drowned at Ross Gold Park. He said her medical bills for three days in the Intensive Care Unit were $180,000.
"We do the best we can," he said about raising his children on a budget drained by medical debt. "It's hard."
McKenzie, with the hospital, said the medical center's policy is to continue to refer patients until they find a doctor who will treat them.
The process may take awhile for Medicaid or Medicare patients, but she said it isn't normal procedure to leave a patient without care.
If all options are exhausted then the on-call ER physician will see the patient.
"We do take responsibility for finding follow-up," she said.