Amid rising costs, sick employees may be left out in the cold. Fighting breast cancer, she lost her job and her insurance at a critical time.

Susan Medina got through chemotherapy and surgery for breast cancer earlier this year.

But then she was fired from her job at an Orlando clothing store -- which meant losing her medical coverage.

"Here I am fighting for my life, and they cut off my insurance right before I was supposed to begin radiation therapy," said Medina, 55. "I think it's inhumane to do that to somebody."

The Orlando mom thinks she is a victim of a growing practice dubbed "health discrimination." Patients' advocates say some companies, squeezed by rising insurance costs, are finding reasons to fire workers with long-term illnesses. Statistics aren't available on how often this happens.

But increasingly, health-care costs are driving a "wedge" between employers and their employees, said Jerry Flanagan with Consumer Watchdog, a California-based advocacy group.

Flanagan said companies traditionally have stood up for their sick workers, even going to the mat for them to get services covered.

"There's been this moral and emotional attachment to their workers," Flanagan said. "But now insurance companies have taught employers that it's in their best interest to weed their ranks of the sick."

Once they are let go, employees can pay to keep their existing plans for up to 18 months through the federal COBRA program. But their costs increase dramatically. For example, Medina would have paid more than $1,000 monthly to continue coverage for herself, her husband and teenage daughter.

So she had to drop them and bought COBRA coverage at $437 a month just for herself.

That's why many workers go without insurance after they're fired, said Kathryn Piscitelli, an Orlando attorney who specializes in employment and civil-rights cases at the firm Harris & Helwig.

'No safety net'

"There really is no safety net," Piscitelli said. "You might think they can always get COBRA, but who can afford that?"

One possible recourse: filing a complaint with the Equal Employment Opportunity Commission, or EEOC, which investigates discriminatory practices. Piscitelli said employees with terminal or chronic illnesses may be protected under the Americans With Disabilities Act.

But there are no guarantees. To get ADA protection, a worker has to show that he is "substantially impaired in a major life activity," Piscitelli said. Cancer patients may have limitations that wax and wane, depending on where they are in treatment. As a result, wrongly fired workers are falling through loopholes.

"The ADA has been construed very, very narrowly by the courts," Piscitelli said. "We need new legislation to ensure that workers with serious conditions have job protection."

A lot of cancer patients struggle with insurance issues, according to a national survey conducted by the Kaiser Family Foundation, the Harvard School of Public Health and USA Today. Of those who responded, 6 percent said they lost their medical coverage after a cancer diagnosis. An additional 11 percent said they couldn't get insurance.

The good news? Most patients who were working at the time of diagnosis said they were treated "very well" by their employers (76 percent), with only 7 percent rating their employer's treatment as "not too well or not well at all."

Despite her firing, Medina said she still has kind feelings toward many of her co-workers at the Catherines clothing store on Colonial Avenue. They stood by her through 16 weeks of chemotherapy.

Return to work

Then she underwent surgery in March and took a month off to recuperate. Medina said her bosses knew -- and agreed it wouldn't be a problem -- that she couldn't lift anything heavy for a while after coming back to work. As a sales clerk, Medina occasionally needed to move and unpack boxes of new clothing.

She had been back on the job a couple of days when they told her she was fired because of her inability to lift, Medina said. Her insurance officially stopped that Friday. She was to start radiation treatment the next Monday. Calls and e-mails to Catherines corporate offices were not returned to the Sentinel.

"I think they just saw me as a liability, and they didn't want to deal with it," Medina said.

Her family now has coverage through her husband's employer. She also has filed a complaint with the EEOC. In the meantime, Medina plans to look for work again after surgery for another health problem: cataracts. It seems like a small matter at this point.

"After you've been through all this, you're really grateful when you feel good," Medina said. "My strength has come back, and my endurance has come back. Aside from my constant worry about money, I feel really good."

Robyn Shelton can be reached at rshelton@orlandosentinel.com or 407-420-5487.