Debi Creekmore was so sick that she couldn't eat. That made her so malnourished that she had to be admitted to Prince William Hospital in Manassas.

She suffers from Crohn's disease, a chronic digestive disease of the small and large intestines. There is no cure; the cause is unknown. It destroys the ability to digest food by clogging shut the intestines.

To save her life, Creekmore's doctor hospitalized her for treatment with total parenteral nutrition (TPN), a technique in which a thin tube is surgically inserted into a large chest vein so a nutritious solution can be fed directly into her bloodstream.

The treatment appears to be working. Creekmore has gained 20 pounds over the last two weeks and now carries 132 pounds on her 5-foot-1-inch frame.

But it's not clear how long she will continue to receive the treatment. Like 37 million Americans, Creekmore lacks health insurance. And while Virginia's Medicaid program will pay for her treatment in the hospital, it will not pay for the treatment at home.

Although she is still in the hospital, her hospitalization coverage under Medicaid already has run out.

That leaves Creekmore, her family, her doctors and the hospital with a classic dilemma: Who should pay for a lifesaving treatment for people with chronic diseases who cannot afford to pay. At this point, the hospital is being forced to absorb the losses.

In Virginia, Medicaid will cover TPN in the hospital, which can cost approximately $200,000 a year. TPN could easily be provided in the patient's home, and it would be far less costly, only about $75,000 a year. Yet Virginia Medicaid refuses to cover it.

"We can't focus on the individual. It might appear to be cost effective {to provide the care at home}, but we're required to provide the same service to everyone," said Dr. Robert Wood, director of medical support for Virginia Medicaid. "We can't make exceptions. Virginia Medicaid, we would say, is quite generous."

So Virginia Medicaid, by its own rules, is forced to pay the higher premium for hospital treatment, but it only does that for 21 days. Creekmore already has been in Prince William Hospital for 35 days.

On Friday, Creekmore plans to challenge Virginia Medicaid's rules in district court. She is trying to prove that the TPN therapy is more than a nutritional supplement, that it is in fact a prescribed medication, which would be covered by Virginia Medicaid.

If she loses, Creekmore said, these bureaucratic complications are likely to threaten her health, and she may be denied an opportunity to live a life that is as full and normal as possible. That, she said, will effect everyone in her family, especially the five children.

It already has cost husband Bill Creekmore his job as a trucker in Prince William County. He simply was missing too much work because of his wife's illness.

Coping has not been easy for the children, either. Because their mother is chronically ill, they miss out on many of the normal mother and child interactions.

It has been hardest on the twins, Jessica and Justin, 22 months old.

"Justin has always been really close to me. When they came up {to see me in the hospital}, the first thing he did was get up here on the bed and lay his little head on my stomach. He wouldn't move an inch," said Creekmore. "He just would not move like 'I'm not going anywhere. I'm here with my mommy and your not taking me.' "

Crohn's disease struck her shortly after the twins were born.

Life, however, has not always been so hard for the Creekmores.

Bill and Debi Creekmore first met in Florida in January of 1983, while both were working as police officers for the Winter Haven Police Department.

At the time, Bill was recently divorced and the father of two children. Debi, also divorced, was the mother of three. They were two people who identified with each other and fell in love. They were married that September.

"We had so much in common, excluding the police department," said Creekmore. "I looked at him like a big brother. We were just two people that could talk to each other."

But then Crohn's struck. Shortly after the disease was diagnosed, Creekmore's private insurance company dropped her because of the bills incurred and her doctor in Florida would not allow her to go back to work because of her illness.

"When I came down with this disease, I was on a medical leave of absence" from a private security firm, Creekmore said. "My medical insurance company dropped me because of the enormous expense, and that's when I had to turn to Medicaid.

"It's frustrating. The disease is bad enough to deal with and cope with," said Creekmore. "There's no reason for me to be in the hospital. I'm taking up a bed someone else could be using. It's a matter of life and death for me."

But the current structure of the health care system and the governmental financing program for people without health insurance leave her few choices.

Debi Creekmore has been unable to work since August of 1986 and was diagnosed the following October. Without a job, Creekmore has little hope of getting affordable health insurance.

And even if she or her husband find work, there is no guarantee that the employer will provide health insurance, especially for a pre-existing condition. Of the 37 million Americans who have insurance, 24.3 million have jobs; their employers simply fail to provide health insurance.

Three weeks after she was diagnosed at the University of South Florida in Tampa, Creekmore was admitted to Tampa General and placed on TPN treatment because her weight had fallen to only 75 pounds.

The TPN put on a tremendous amount of weight immediately because she was so malnourished and dehydrated. However, she was not getting any healthier so the doctors at Tampa General decided to operate.

Surgery is not a cure for Crohn's disease, but it can give relief for some. The doctors removed part of her small intestine.

For a few weeks she felt a little bit better, but then the pain and other symptoms came back with the same intensity as before the operation. She wasn't able to keep anything down. Creekmore was either vomiting or having diarrhea up to 20 times a day.

In August of 1986, when she first had to stop working because she was ill, Creekmore decided to apply for Social Security disability.A full year after she first applied, Creekmore was turned down because she did not meet the criteria set up by the Disability Determination Service, which evaluates disability claims for Social Security. The threshold for disability payments depends partly on people's weight as related to their height.

Creekmore's weight was significantly more than 75 pounds by the time she was denied the Social Security disability, because of the combination of the TPN treatment and treatment with steroids, drugs that help control the symptoms of her disease. Both of these treatments are known for putting weight on.

"It was clear that they {the Disablilty Determination Service} were focusing on the weight loss, which they seem to do," said Bruce Billman, an attorney working with Creekmore in filing an appeal in the Social Security case.

Creekmore and her family moved to Prince William County in May to be closer to her mother, grandmother and an aunt, primarily to get help with the children.

Despite the family support, the disease has been stressful for everyone..

"It's been really hard for me to accept this disease -- and not just for myself. " she said, her voice trailing off. "The kids are used to having a mommy who took them swimming and was very active and the disease has just totally altered my life style."

Her husband Bill Creekmore simply put it this way: "I just didn't think life could be this hard."

Deborah Schwartz is a Washington writer.