Tagged Emergency Medicine

COVID-19 Overwhelms Border ICUs

CHULA VISTA, Calif. — Even as most California hospitals have avoided an incapacitating surge in coronavirus patients, some facilities near the Mexican border have been overwhelmed. They include El Centro Regional Medical Center in Imperial County and Scripps Mercy Hospital Chula Vista in San Diego County, which link the spike in COVID-19 patients to their communities’ cross-border lifestyle.

Some U.S. citizens and legal residents who live in Mexico are crossing the border from Tijuana and Mexicali into the U.S. for treatment. Dr. Juan Tovar, an emergency physician and chief operations executive for Scripps Mercy Hospital Chula Vista, said 48% of COVID-positive patients who visited the emergency room between May 24 and May 30 said they had recently traveled to Mexico. That figure jumped to 60% between May 31 and June 2. The hospital is about 10 miles from the San Ysidro Port of Entry, the busiest land border crossing in the Western Hemisphere.

Only about 5% of COVID-19 patients reported they’d recently been to Mexico at Scripps’ three other emergency rooms farther north, he said.

“We are now transferring COVID-19 patients out of Chula Vista to other Scripps hospitals farther north on a fairly regular basis — 21 over the last week — to help decompress our hospital here,” Tovar said.

About two hours east, El Centro Regional Medical Center was so overwhelmed by COVID-19 patients it had to divert some to health care facilities in San Diego, National City and elsewhere. There have been more than 2,025 confirmed cases in Imperial County, which has the highest COVID-19 hospitalization rate in the state, said Andrea Bowers, special projects coordinator for the county health department.

“We know that our community has family on both sides of the border, so we’re relating the uptick to Mother’s Day weekend,” said Suzanne Martinez, assistant chief nursing officer at the medical center. “That means more risk as people travel back and forth over the border.”

KHN’s Heidi de Marco visited the intensive care units at both hospitals and documented the efforts to keep patients alive.


Patients suspected of having COVID-19 are screened inside a makeshift triage center outside El Centro Regional Medical Center in El Centro, California. The hospital is trying to keep patients who do not require acute care out of the hospital to limit spread.(Heidi de Marco/KHN)


Nurse Brianna Mendoza wheels a patient with coronavirus symptoms into the triage tent on May 28, 2020. “I’ve had a few people saying that they have had to cross the border to come here” because they prefer to get care in the U.S., Mendoza says.(Heidi de Marco/KHN)

Sylvia Cervantes, a medical assistant, assesses a patient who might have COVID-19. Cervantes usually works in the oncology department but was assigned to help in the triage tent.(Heidi de Marco/KHN)


A health care worker prepares to treat a COVID-19 patient on the medical-surgical floor. On May 28, the hospital had 41 coronavirus patients.(Heidi de Marco/KHN)


A registered nurse wearing protective equipment treats a COVID-19 patient in the intensive care unit. Ten beds in the hospital’s 12-bed ICU were filled with coronavirus patients.(Heidi de Marco/KHN)


Health care workers must wear a special respirator, a gown and gloves before entering a COVID-19 patient’s room.(Heidi de Marco/KHN)


Hospital staff members tending to COVID-19 patients must put on full-body protective suits to enter an isolation room in the emergency department.(Heidi de Marco/KHN)


El Centro Regional Medical Center is about 20 minutes north of Calexico, California, an ordinarily bustling border town with street shops and food vendors. But during the COVID-19 pandemic, the streets are quiet and nearly empty.(Heidi de Marco/KHN)

People make their way to Mexicali, Mexico, through the border crossing at Calexico. According to the U.S. Department of State, about 1.5 million U.S. citizens live in Mexico. In the Mexican state of Baja California, there are more than 5,380 confirmed coronavirus cases. Mexicali, the capital, has at least 2,630, more than any other city in the state.(Heidi de Marco/KHN)


About two hours to the west, Scripps Mercy Hospital Chula Vista has had roughly 35 to 40 COVID-19 patients every day in recent weeks, says Dr. Juan Tovar, an emergency physician and chief operations executive. That’s quadruple the number of coronavirus patients the hospital was treating at the beginning of April.(Heidi de Marco/KHN)


Paloma Garza-Johnson is a registered nurse at Scripps Mercy Hospital Chula Vista.(Heidi de Marco/KHN)

Garza-Johnson dons her personal protective gear in the hallway outside an ICU patient’s room on May 29.(Heidi de Marco/KHN)


ICU staffers sometimes communicate with one another through the windows using a whiteboard.(Heidi de Marco/KHN)


Registered nurse Christina Campolongo (left), certified nursing assistant Vanessa Aquino and registered nurse Paloma Garza-Johnson turn a sedated coronavirus patient into the prone position, face down, which may allow more oxygen into the patient’s lungs.(Heidi de Marco/KHN)


The Rev. Mark Weber, coordinator of chaplaincy services at Scripps Mercy Hospital Chula Vista (left), and the Rev. Emmanuel Ochigbo, a chaplain, pray outside a coronavirus patient’s room before performing the sacrament of healing.(Heidi de Marco/KHN)

Ochigbo wets his finger with oil before entering the room to anoint the patient.(Heidi de Marco/KHN)


Ochigbo administers the sacrament of healing. The Anointing of the Sick is given to seriously ill and dying people. Ochigbo has modified it for COVID-19 patients, applying oil only to the forehead and feet.(Heidi de Marco/KHN)

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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Nearly Half Of Americans Delayed Medical Care Due To Pandemic

As the coronavirus threat ramped up in March, hospitals, health systems and private practices dramatically reduced inpatient, nonemergency services to prepare for an influx of COVID-19 patients. A poll released Wednesday reveals that the emptiness of medical care centers may also reflect the choices patients made to delay care.

The Kaiser Family Foundation poll found that 48% of Americans said they or a family member has skipped or delayed medical care because of the pandemic, and 11% of them said the person’s condition worsened as a result of the delayed care. (KHN is an editorially independent program of the foundation.)

Medical groups have noted a sharp drop-off in emergency patients across the country. Some, including the American College of Emergency Physicians, American College of Cardiology and American Heart Association, have publicly urged people concerned about their health to seek care.

Dr. William Jaquis, president of the American College of Emergency Physicians, said the anecdotes he’s heard of people delaying care have been troubling, with patients suffering heart attacks or strokes at home. He urged people not to skip going to the emergency room, and pointed out the many safety precautions hospitals are taking to curb the spread of the coronavirus.

“Don’t sit at home and have a bad outcome,” Jaquis said. “We’re certainly there and in many ways very safe, and, especially with low volumes in some places, we’re able to see people quickly. Come on in, please.”

According to the poll, nearly 7 in 10 of those who had skipped seeing a medical professional expect to get care in the next three months.

Despite a significant number of adults saying they delayed care, 86% of adults said their physical health has “stayed about the same” since the onset of the outbreak in the U.S.

Nearly 40% of Americans, however, said stress related to the coronavirus has negatively affected their mental health. Women were more likely than men to say the coronavirus has had a negative impact on their mental health, and those living in urban and suburban areas were more likely to say this than those living in rural areas. Nearly half of those living in households that have experienced income or job loss said the pandemic had a negative effect on their mental health.

The poll further reports on some of the economic consequences of the pandemic. It found that about 3 in 10 adults have had trouble paying household expenses, with 13% expressing difficulty paying for food and 11% paying medical bills. Nearly 1 in 4 adults said they or a family member in the next year will likely turn to Medicaid, the federal-state health insurance program for low-income residents.

Medicaid continues to show strong support among Americans. About three-quarters said they would oppose efforts by their states to cut the program as part of cost reductions.

The poll was conducted May 13-18 among 1,189 adults. The margin of sampling error is +/-3 percentage points for the full sample.

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Casi la mitad de las personas han retrasado su atención médica por la pandemia

A medida que la amenaza del coronavirus fue aumentando en marzo, hospitales, sistemas de salud y consultorios redujeron drásticamente los servicios que no eran de emergencia para prepararse para una afluencia de pacientes con COVID-19.

Pero una nueva encuesta revela que este vacío en la atención no fue solo porque los centros de salud se estaban preparando, sino también porque muchos pacientes decidieron atrasar procedimientos y citas.

En la encuesta realizada por la Kaiser Family Foundation (KFF), el 48% de los estadounidenses dijo que ellos mismos o un miembro de la familia habían salteado o retrasado atención médica por la pandemia, y el 11% de ellos dijo que la condición médica empeoró por culpa de ese atraso.

Grupos médicos han notado una fuerte caída en el número de pacientes de emergencia en todo el país. Algunos, como el Colegio Estadounidense de Médicos de Emergencia, el Colegio Estadounidense de Cardiología y la Asociación Americana del Corazón, han instado públicamente a las personas preocupadas por su salud a no dejar de ir al médico.

El doctor William Jaquis, presidente del Colegio Estadounidense de Médicos de Emergencia, dijo que las historias que ha estado escuchando sobre las personas que retrasan la atención han sido preocupantes: por miedo al coronavirus están sufriendo ataques cardíacos o accidentes cerebrovasculares en sus hogares.

Jaquis instó a las personas a no dejar de ir a la sala de emergencias si tienen un ataque, y remarcó todas las precauciones de seguridad que los hospitales están tomando para frenar la propagación del coronavirus.

“No se siente en casa hasta que algo salga realmente mal”, dijo Jaquis. “Estamos allí y, en muchos sentidos, muy seguros. Y, especialmente en algunos lugares, con un muy bajo volumen de pacientes, por lo que podemos ver a las personas rápidamente. Venga, por favor”.

Según la encuesta, casi 7 de cada 10 de los que habían decidido postergar una cita médica esperan recibir atención en los próximos tres meses.

A pesar que un número significativo de adultos dijo que retrasó la atención, el 86% expresó que su salud física “se ha mantenido casi igual” desde el inicio del brote en los Estados Unidos.

Sin embargo, casi el 40% dijo que el estrés relacionado con el coronavirus ha afectado negativamente su salud mental.

Las mujeres fueron más propensas que los hombres a decir que la pandemia había tenido un impacto negativo en su salud mental, y aquéllos que viven en áreas urbanas y suburbanas sufrieron más este impacto que las personas que viven en zonas rurales.

Casi la mitad de las personas que viven en hogares que han experimentado pérdida de ingresos o de empleo dijeron que la pandemia tuvo un efecto negativo en su salud mental.

La encuesta también informa sobre algunas de las consecuencias económicas de la pandemia. Se encontró que aproximadamente 3 de cada 10 adultos han tenido problemas para pagar los gastos del hogar, con un 13% expresando dificultades para pagar la comida y un 11% para cubrir las facturas médicas.

Casi 1 de cada 4 adultos dijo que la persona misma o un miembro de la familia en el próximo año probablemente recurrirán a Medicaid, el seguro de salud federal gerenciado por los estados para residentes de bajos ingresos.

Medicaid sigue teniendo un fuerte apoyo. Cerca de las tres cuartas partes dijo que se opondrían a los esfuerzos de sus estados para reducir el programa como parte de recortes de presupuesto.

La encuesta se realizó del 13 al 18 de mayo entre 1,189 adultos. El margen de error de muestreo es +/- 3 puntos porcentuales para la muestra completa.

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COVID-Like Cough Sent Him To ER — Where He Got A $3,278 Bill

From late March into April, Timothy Regan had severe coughing fits several times a day that often left him out of breath. He had a periodic low-grade fever, too.

Wondering if he had COVID-19, Regan called a nurse hotline run by Denver Health, a large public health system in his city. A nurse listened to him describe his symptoms and told him to immediately go to the hospital system’s urgent care facility.

When he arrived at Denver Health — where the emergency room and urgent care facility sit side by side at its main location downtown — a nurse directed him to the ER after he noted chest pain as one of his symptoms.

Regan was seen quickly and given a chest X-ray and electrocardiogram, known as an EKG, to check his lungs and heart. Both were normal. A doctor prescribed an inhaler to help his breathing and told him he might have bronchitis. The doctor advised that he had to presume he had COVID-19 and must quarantine at home for two weeks. At the time, on April 3, Denver Health reserved COVID tests for sicker patients. Two hours after arriving at the hospital, Regan was back home. His longest wait was for his inhaler prescription to be filled.

Regan wasn’t concerned just about his own health. His wife, Elissa, who is expecting their second child in August, and their 1-year-old son, Finn, also felt sick with COVID-like symptoms in April. “Nothing terrible, but enough to make me worry,” he said.

When Timothy had coughing fits and a low-grade fever from late March into April, his COVID-19 worries weren’t only about himself. He was also concerned for his pregnant wife, Elissa, and their 1-year-old, Finn, both of whom also felt sick with COVID symptoms in April.(Ethan Welty for KHN)

Regan, who is an estimator for a construction firm, worked throughout his sickness — including while quarantined at home. (Construction in Colorado and many states has been considered an essential business and has continued to operate.) Regan said he was worried about taking a day off and losing his job.

“I was thinking I had to make all the money I could in case we all had to be hospitalized,” he said. “All I could do was keep working in hopes that everything would be OK.”

Within a couple of weeks, the whole family, indeed, was OK. “We got lucky,” Elissa said.

Then the bill came.

The Patient: Timothy Regan, 40, an estimator for a construction company. The family has health insurance through Elissa’s job at a nonprofit in Denver.

Total Bill: Denver Health billed Regan $3,278 for the ER visit. His insurer paid $1,042, leaving Regan with $2,236 to pay based on his $3,500 in-network deductible. The biggest part of the bill was the $2,921 general ER fee.

Service Provider: Denver Health, a large public health system

Medical Service: Regan was evaluated in the emergency room for COVID-like symptoms, including a severe cough, fever and chest pain. He was given several tests to check his heart and lungs, prescribed an inhaler and sent home.

What Gives: When patients use hospital emergency rooms — even for short visits with few tests — it’s not unusual for them to get billed thousands of dollars no matter how minor the treatment received. Hospitals say the high fees come from having to staff the ER with specialists 24 hours a day and keep lifesaving equipment up to date.

Denver Health coded Timothy’s ER visit as a Level 4 — the second-highest and second-most expensive — on a 5-point scale. The other items on his bill were $225 for the EKG, $126 for the chest X-ray and $6 for his albuterol inhaler, a medication that provides quick relief for breathing problems.

The Regans knew they had a high deductible and they try to avoid unnecessarily using the ER. But, with physician offices not seeing patients with COVID-type symptoms in April, Timothy said he had little choice when Denver Health directed him first to the urgent care, then to its ER. “I felt bad, but I had been dealing with it for a while,” he said.

Elissa said they were trying hard to do everything by the book, including using a health provider in their plan’s network.

“We did not anticipate being hit with such a huge bill for the visit,” Elissa said. “We had intentionally called the nurse’s line trying to be responsible, but that did not work.”

In an effort to remove barriers from people getting tested and evaluated for COVID-19, UnitedHealthcare is one of many insurers that announced it will waive cost sharing for COVID-19 testing-related visits and treatment. But it is not clear how many people who had COVID symptoms but did not get tested when tests were in short supply have been billed as the Regans were.

Timothy and Elissa try to avoid needlessly visiting the ER because of their high-deductible insurance plan, they say. Denver Health billed $3,278 for Timothy’s ER visit, leaving the Regans with a $2,236 tab based on their $3,500 in-network deductible. UnitedHealthcare officials reviewed his case at the request of KHN, and waived the couple’s cost sharing for the visit.(Ethan Welty for KHN)

Resolution: A Denver Health spokesperson said Regan was not tested for COVID because he was not admitted and did not have risk factors such as diabetes, heart disease or asthma. He was not billed as a COVID patient because he was not tested for the virus. The medical center has since expanded its testing capacity, the spokesperson said.

UnitedHealthcare officials reviewed Regan’s case at the request of KHN. Based on Regan’s symptoms and the tests performed, Denver Health should have billed them using a COVID billing code, an insurer spokesperson said. “We reprocessed Mr. Regan’s original claims after reviewing the services that he received,” a United Healthcare spokesperson said. “All cost share for that visit has been waived.”

The Regans said they were thrilled with UHC’s decision.

“That is wonderful news,” Elissa Regan said upon hearing from a KHN reporter that UHC would waive their costs. “We are very thankful. It is a huge relief.”

Timothy, Elissa and Finn all experienced COVID symptoms. Though they tried to do everything by the book, a trip to the ER for Timothy resulted in a $2,236 tab for the Regans, before their health insurer, UnitedHealthcare, subsequently waived it.(Ethan Welty for KHN)

The Takeaway: The Regans said they initially found no satisfaction in calling the hospital or the insurer to resolve their dispute ― but it was the right thing to do.

“He’s definitely not alone,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “The takeaway here is both the provider as well as insurance company are still on a learning curve with respect to this virus and how to bill and pay for it.”

Corlette said Timothy should not have second-guessed his decision to use the Denver Health ER when directed there by a nurse. That, too, was the right call.

Insurers’ moves to waive costs associated with COVID testing and related treatment is vital to stemming the outbreak — but it works only if patients can trust they won’t get stuck with a large bill, she said. “It’s a critical piece of the public health strategy to beat this disease,” Corlette said.

To help with billing, she said, patients could ask their provider to note on their medical chart when they are seeking care for possible COVID-19. But it’s not the patient’s responsibility to make sure providers use the right billing code, she said. Patients need to know they have the right to appeal costs to their insurer. They can also seek assistance from their employer’s benefits department and state insurance department.

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

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