HERRIN - "Now what?"

Several times each day, Marion Rolla asks the same two-word question. Despite a yeoman effort by his family, friends and the staff at Herrin Hospital, nobody has been able to answer that question.

Less than four months ago Rolla, 53, appeared to have his life on course. A special education teacher at Zeigler-Royalton High School, Rolla had a longtime love interest, two grown daughters, a grandbaby on the way and nearly 30 years teaching under his belt.

On the night of Dec. 19, 2006, Rolla's life went far off course.

Returning to his Christopher home Rolla fell on his porch striking his head with enough force to fracture his skull in three places. Rolla's brother witnessed the fall and called 911. Rolla was transported to Franklin Hospital in Benton, then airlifted to Deaconess Hospital in Evansville where he remained in a coma for 29 days.

"If it hadn't been for his brother he would have probably died," said Merry Jo Arvai, Rolla's girlfriend. "And Benton (hospital) did a good job keeping him alive until he could be airlifted."

In Evansville, emergency surgery was performed to relieve swelling on the brain, and he was placed on a ventilator. Rolla's life hung in the balance for several days.

Shortly after Rolla came out of the coma he was moved to a rehabilitation facility, also in Evansville, where according to Arvai he began to make immediate improvement.

"It was just like somebody flipped a switch," Arvai said. "He was going through four and five hours of therapy a day and he was walking and talking. He was confused, he didn't know why he was there, but he knew people and was making progress."

After two months at the rehab facility, and still showing progress, Rolla's family was told his insurance would not pay for any more rehabilitation. While that termination letter marked the end of his rehab therapy, it also marked the beginning of a long and difficult odyssey for his family.

Rolla was taken to a nursing home in Southern Illinois but turned away because he was not bedridden.

"They took a piece of his skull out when they did the surgery, and it's still out, so he's very high risk," Arvai said. "If he fell it could kill him."

Family members took Rolla home but soon realized they couldn't properly attend to his needs. He was taken March 9 to Herrin Hospital, where he still remains as a patient and in limbo. Rolla's family signed a waiver to allow hospital officials to discuss the unique situation.

Becky Ashton, administrator at the hospital, said medically speaking Rolla is stable. She said he also still needs reconstructive surgery to replace the piece of skull that was removed.

"All we can do for him here is give him custodial care, just basic care, we're not doing anything for him medically," Ashton said. "He doesn't need hospital care; he needs cognitive and behavioral rehab."

According to Ashton the only facility in Southern Illinois equipped to handle Rolla's needs is the Center for Comprehensive Services (CCS) in Carbondale. However, the facility does not have a charity program, doesn't accept Medicaid cases and only takes insurance and private pay patients. The cost is $965 per day.

Ashton said the insurance has offered to pay up to $400 per day and CCS has offered to negotiate the price down to $600 per day. Those negotiations have broken off and Rolla has been denied payment for both physical rehab and his hospital care at Herrin.

That $200 difference has left Rolla's future in limbo and slowed his chance for recovery.

"This is a very difficult case and there's no agreed opinion on how much he can or will improve if he receives additional therapy," Ashton said. "But there's nothing to be done for him here except basic care, there's nothing medically to be done. All we're trying to do now is keep him safe."

Kelly Pool, clinical case manager at Herrin Hospital, has spent countless hours during the past three weeks trying to find care for Rolla's particular type of injury. Adding even more difficulty to an already difficult situation, Pool said in his current condition no facility will take Rolla, period.

As evidence, she produced a list of 68 facilities throughout the region that she has contacted personally. Each facility also was faxed copies of Rolla's medical records.

"This is a very rare case," Pool said. "We're an acute care facility; we're not a behavioral therapy facility. This is not what acute care is about. We've had two people every weekday all day long working on this. He's progressed beyond what we can offer here. We just need to find a facility that can appropriately treat him."

Ashton said Rolla's head injury coupled with living in Southern Illinois creates a twofold problem.

"I don't believe you can say that he has fallen through the cracks, I believe this is an underserved area," Ashton said. "It's difficult to find care for this type of patient and then when you do it's very expensive. It's just a sad situation all the way around."

Arvai has spent time with Rolla every day since he's been a patient at Herrin. She says she believes a good portion of his memory is intact.

"He knows his family and he knows his students. It just seems like everything is in there but it's just jumbled up," Arvai said. "I really believe with the progress he's already made that if he could get the therapy he needs he could live a pretty normal life."

Rolla's oldest daughter, Jennifer Tolley, 25, a full-time grade school teacher, called the ordeal a "nightmare."

"Herrin Hospital has been wonderful and they've done what they could do," Tolley said. "If it wasn't for Herrin we'd be in a big bind about what to do. On top of everything else, just seeing him like this is hard."

Pool was asked the answer to Rolla's frequent question of, "now what."

"We're working on it every day while we're trying to keep him safe and out of harm," she said. "But right now I don't have an answer to that question."

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