Recently thousands of letters went out across Las Vegas telling cancer patients that the only public hospital in the state was closing its outpatient clinic for chemotherapy.
It's the next thing in the recession - communities cutting back on services like schools or cops or public hospitals because tax revenues have fallen with the economy.
One of the charity patients who got that letter in Las Vegas is Helen Sharp, who didn't realize how a crash on Wall Street might threaten her life.
"I don't want to die. I shouldn't have to die. This is a county hospital. This is for people that, like me, many people have lost their insurance, have not any other resources. I mean I was a responsible person. I bought my house. I put money away. I raised my two children. And now I have nothing. You know my house isn't worth anything. I have no money. And I said 'What do I do, but what do all these other people do after me?' 'And they said we don't know,'" Sharp told 60 Minutes correspondent Scott Pelley.
Sharp, 63, has been fighting lymphoma since July. She's not working because of her illness and has no insurance. Last year, she received charity care at the county hospital, University Medical Center. She was one of 2,000 patients who got the letter.
"Dear patient, we regret to inform you that the Nevada Cancer Institute will no longer provide contract oncology services at University Medical Center," Sharp read.
Since December 31, there has been no chemotherapy for new outpatients.
Asked what reading this letter meant to her, Sharp told Pelley, "A death sentence."
University Medical Center is the safety net for two million people; Las Vegas bets its life on it. UMC is a teaching hospital, the only fully equipped trauma center, the only burn unit, the only transplant unit, and the primary source of charity care in a city that has fallen on the hardest times it has ever seen.
"Obviously, our gaming and tourism is tanking. The construction industry has been decimated. And all of those things cause big, gaping holes in the state budget. The hardest-hit area for us was the Medicaid budget," Kathy Silver, the hospital's CEO, explained.
Silver had signed that letter patients received.
Literally overnight, UMC's budget was cut by $21 million. "And we were already scheduled or budgeted to lose $51 million. And so, when you layered on $21 million on top of that, that brought our loss, or anticipated loss, to $72 million," Silver told Pelley.
The $21 million was cut by the legislature when tax revenues went bust. Nevada is number one in foreclosures; unemployment is over 10 percent, double what it was last year and climbing.
Silver told 60 Minutes she had to defend her unique services like the trauma center, so she chose to sacrifice services that are duplicated at private hospitals, even though patients may not be able to afford them.
Asked what services she had closed, Silver said, "We no longer provide prenatal services. We closed the outpatient oncology program. We cancelled a contract for outpatient dialysis. We closed the dedicated high risk obstetrical unit that we had. And we stopped doing outpatient mammography."
60 Minutes was there in February when the women's cancer clinic closed.
"When the hospital first informed you that the outpatient oncology clinic was closing, what did you think?" Pelley asked Dr. Nick Spiritos, who treats ovarian and uterine cancers.
"How can you do this to cancer patients? They're dying. If we don't provide them care, their outcome is guaranteed. They're going to die," he replied.
Pelley spoke to several of those patients. Roy Scales, a laid off security guard with lung cancer, went to the hospital and got the news in person.
"I walked in, the lady looked down and said 'Well, I don't see anything down here for you.' Then she looked in the computer and she said, 'Oh, you were supposed to have an oncology today but it's been canceled. Our oncology department is closed,'" Scales remembered.
"They turned you away at the door," Pelley remarked.
"They turned me away at the door without telling me anything," Scales said.
Asked what he was thinking when he walked out of the hospital, Scales told Pelley, "I mean where am I going to find help? I mean, I'm messing with a disease that will kill you. And for every day that I don't get medical input, I mean, this advances on my body."