San Francisco — Dr. Laura Scrimgeour had never met a female cardiothoracic surgeon until she met Dr. Amy Fiedler.

“I think it’s a real problem for women in medicine in all fields, but particularly in surgery,” Scrimgeour told CBS News.

Scrimgeour is a fellow working under Fiedler at the University of California, San Francisco Medical Center, and the two are among just a handful of women in their field.

“I get mistaken for a nurse,” Fiedler said. “I get mistaken for a physical therapist, one time for food service. I mean, pretty much anything other than being the cardiac surgeon.”

Women were 32% more likely to die if treated by a male surgeon rather than a female one, a study from the University of Toronto’s Temerty Faculty of Medicine found. The study also determined that men were less likely to die at the hands of female surgeons.

“Even just to have one person to look up to can make all the difference for some people,” Scrimgeour said.

Even though more than 50% of medical school students are women, a gender gap remains in top specialties, according to data from the Association of American Medical Colleges (AAMC). Only 8% of thoracic surgeons are women, the AAMC found. 

Fiedler and Scrimgeour said getting more women in leadership at hospitals can lead to better family leave policies and more opportunities for female physicians. Patients can also help by requesting female doctors.

“We’re thinking about and trying to figure out how we can get more women, get more people of color, get more diversity at the higher ends of academic leadership,” Fiedler said.
 
Dr. Charlene Blake is a cardiac anesthesiologist who was on a UCSF team that made history in December when it became what is believed to be the first all-female heart transplant team.

“I had to look around the room,” Blake said. “I was like, ‘Oh, we’re all women here. This is incredible. I haven’t seen this before.'”

“Every single person in that room that day that we did that heart transplant deserved to be there and is a high performer and was providing the absolute best care to that patient,” Fiedler added. “And I think that’s really inspiring.”

Oyewale Tomori is a virologist and fellow at the Nigerian Academy of Science.

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In April, the Centers for Disease Control and Prevention warned doctors about two growing outbreaks of deadly Marburg virus in Africa. World Health Organization officials confirmed in February an outbreak in Equatorial Guinea of the highly infectious disease, which is in the same family as the virus that causes Ebola. The Conversation Africa’s Wale Fatade and Usifo Omozokpea asked virologist Oyewale Tomori about its origin and how people can protect themselves against the disease after cases were confirmed in Ghana in July 2022.

What is the Marburg virus and where did it come from?

Marburg virus causes the Marburg Virus Disease, formerly known as Marburg hemorrhagic fever. The virus, which belongs to the same family as the Ebola virus, causes severe viral hemorrhagic fever in humans with an average case fatality rate of around 50%. It has varied between 24% to 88% in different outbreaks depending on virus strain and case management.

It was first reported in 1967 in a town called Marburg in Germany and in Belgrade, Yugoslavia (now Serbia). There were simultaneous outbreaks in both cities. It came from monkeys imported from Uganda for laboratory studies in Marburg. The laboratory staff got infected as a result of working with materials (blood, tissues and cells) of the monkeys. Of 31 cases associated with these outbreaks, seven people died.

After the initial outbreaks, other cases have been reported in different parts of the world. Most were in Africa – Uganda, the Democratic Republic of Congo, Kenya, South Africa, and more recently in Guinea and Ghana. Serological studies have also revealed evidence of past Marburg virus infection in Nigeria.

While the host, or reservoir, of the virus is not conclusively identified, the virus has been associated with fruit bats. In 2008, two independent cases were reported in travelers who had visited a cave inhabited by Rousettus bat colonies in Uganda.

How is it spread?

It is spread through contact with materials (fluids, blood, tissues and cells) of an infected host or reservoir. In the case of the monkeys from Uganda imported into Marburg, laboratory staff obviously got infected through contact with the tissues and the blood of the monkeys.

There can also be human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials. This includes materials like bedding, and clothing contaminated with these fluids.

But there’s a great deal we don’t know: For example, whether contact with bat droppings in caves can cause infections in people.

What are the symptoms? And how bad can they be?

After an incubation period of between 2 to 21 days, there is a sudden onset of the disease marked by fever, chills, headache, and myalgia.

Around the fifth day after the onset of symptoms, maculopapular rash, most prominent on the trunk (chest, back, stomach), may appear. Nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhea may appear. Symptoms become increasingly severe and can include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction.

The mortality is around 50%, and could be as high as 88% or as low as 20%.

This tells us it’s quite a severe infection. The two people infected in Ghana both died.

Can it be treated?

Not really, but early supportive care with rehydration, and symptomatic treatment, improves survival.

What can people do to protect themselves?

Avoid exposure to the virus as much as possible, and protect against discharges from infected people.

Also, because of the similarities in the symptoms of many hemorrhagic fever diseases, especially during the early stages, there is a need for reliable laboratory confirmation of a case of Marburg virus infection. And once that is done – as with Ebola – the person must immediately be isolated and avoid contact with other people.

What should be done to ensure the virus doesn’t spread?

There is no holiday from disease outbreaks. That means as a country, surveillance cannot take a break or a holiday.

Given that there have been cases in Ghana, it’s time to be on the alert. Proper screening is called for. Arrivals from Ghana and other West African countries must be checked at the ports of entry.

Unfortunately, it doesn’t appear as if anybody is thinking of that now. The attitude seems to be: oh, there are only two cases in Ghana.

But I think it’s the best time to be on the alert at the ports of entry, especially for people from countries where cases are reported. Studies done in Nigeria in the the 1980s and more recently in the 1990s provide evidence of possible previous infections with Marburg virus – or a related virus – in certain Nigerian populations. This leads me to believe that the virus is probably more widespread than we think it is. We need an improvement in diagnosis which can help us do the detection as quickly, and as efficiently as possible.

On top of this, countries need to improve their disease surveillance and laboratory diagnosis to enhance and improve the capacity for a more definitive diagnosis of viral hemorrhagic fever infections.

This article is republished from The Conversation under a Creative Commons license, where it was originally published in July 2022.

Scientists have found that climate change may lead to an increase in so-called flesh-eating bacteria in the waters along the East Coast of the U.S.

The bacteria Vibrio vulnificus is usually found in warm waters with low salinity, or salt content. While the bacteria is common in subtropical regions, there has been an increase of infections from Vibrio in more northern locations, such as the Delaware Bay. 

This is likely due to warming coastal waters, according to the study published in the Scientific Reports journal. An increase in temperature affects the salinity of the water, which the bacteria favors.

Climate change, population growth and an increasingly elderly population will contribute to the surge in these infections, the researchers say. 

There are currently about 100 cases of these infections each year in the U.S. and the Gulf Coast is considered a “global hotspot” for the bacteria. The study looked at cases from the Gulf and Atlantic coastlines of the U.S. over 30 years. 

The researchers looked for changes in the disease’s distribution and found between 1988 and 2018, the annual amount of these infections increased from 10 to 80, and the cases shifted north. This led the researchers to project that by 2081 to 2100 the cases may reach areas like New York – and they may double. 

They believe in the next 20 years or so, the infections will creep up about 11,000 km of the coastline and in the next 70 years, they could be found more than 14,400 km up the coast, reaching as far as the St. Lawrence River in Canada. That means by 2100, an estimated  90 million to 210 million people will be at risk.

People over 60 are more susceptible to the infection, and with the over-60 age group increasing, cases for that group could double by 2041–2060 or triple by 2081–2100.

Vibrio infections can be caused by eating raw or undercooked seafoods, but Vibrio vulnificus is a form of it that infects wounds and is often referred to “flesh-eating bacteria,” according to the Centers for Disease Control and Prevention. 

An infection can occur when a small lesion in the skin is exposed to the bacteria in seawater. The bacteria can cause the area to die, causing the patient to need urgent surgery to remove the tissue or risk amputation, the study says.

While the infections are still rare, mortality rates are high – about 18 percent. Most fatalities occur within 48 hours of exposure.

Treating these infections also the most expensive marine pathogens to treat, with the U.S. spending $ 320 million a year, according to the study. 

The CDC advises people with wounds, including those from surgery, tattoos or piercings, to stay out of saltwater or brackish water, to cover their wounds with a waterproof bandage and to thoroughly wash cuts, especially after contact with saltwater, brackish water or raw seafood and its juices. 

A study in 2019 found these infections had started occurring outside the traditional geographic boundaries, and more often. In just two years, five cases of Vibrio vulnificus had been linked to the Delaware Bay, according to a study. One of the patients died. 

3 deaths linked to recalled eye drops

Three people have died and eight others have lost their vision as a result of drug-resistant bacteria infections linked to recalled eye drops, according to the Centers for Disease Control and Prevention. The CDC is warning against using EzriCare and Delsam Pharma artificial tears, which have been recalled due to the outbreak.

Adam Di Sarro is a fire captain in Naples, Florida, who for years used artificial tears for dryness in his left eye. He never had a problem until last fall. 

“The redness came on, the irritation came on, a lot of itching, and it was abnormal,” Di Sarro said. “It just progressively got worse, to the point where I couldn’t even see within a few hours.”

Unable to treat the problem with antibiotics, doctors feared Di Sarro would lose his eye.

“That was hard,” he told CBS News. “And is still hard because I’m still not at work, going on five months.”

The CDC is investigating a nationwide outbreak of the antibiotic-resistant bacteria — Pseudomonas aeruginosa — which has infected 68 people in 16 states. 

Dr. Guillermo Amescua of the Bascom Palmer Eye Institute in Miami treated Di Sarro with an experimental light treatment that finally killed the infection.

Amescua said that anyone who notices something wrong while using artificial tears should see their eye care provider as soon as possible.

Di Sarro is suing for negligence and hopes that surgery will restore sight in his left eye. Neither EzriCare nor Amazon, where Disarro purchased the eye drops, would comment.

Symptoms from the infection can include pain, discharge, redness, light sensitivity and blurry vision, according to the CDC.

To use eye drops safely in general, people should wash their hands and keep the tip of the bottle sterile.

Manuel Bojorquez

Manuel Bojorquez is a CBS News national correspondent based in Miami. He joined CBS News in 2012 as a Dallas-based correspondent and was promoted to national correspondent for the network’s Miami bureau in January 2017. Bojorquez reports across all CBS News broadcasts and platforms.

Black Angels remembered for treating tuberculosis patients decades ago

NEW YORK — As we celebrate Women’s History Month, we have a little-known story about nurses on the front line of a pandemic, but this one is not about COVID-19.

Back in the early 1900s, tuberculosis was reported to be responsible for nearly 18% of all deaths in New York City. This is a story of how Black nurses stepped in to care for the patients, and it introduces one of the last living “Black Angels.”

“When I came here, I was 16, working as a nurse’s aide and I got my training through Seaview Hospital,” Virginia Allen said.

That was in 1947. Allen left her home in Detroit to follow her aunt, who was working as a nurse at the Staten Island hospital. Seaview opened in 1913, specifically to treat patients who were suffering from tuberculosis, a horrific disease that was killing millions.

“I was too young to be sophisticated enough to be afraid,” Allen said. “A lot of people wanted to forget about tuberculosis, because it was so devastating to so many.”

By 1929, almost all of the white nurses there refused to care for patients.

“Most of them worked in administration, and they never really worked on the ward with the patients,” Allen said.

So Black nurses were recruited from around the country. The front-line caregivers, about 300 of them, became known as the “Black Angels.”

“This gave them an opportunity to work in a non-segregated environment, and to use the skills that they were taught. And that was reason enough to come here,” Allen said. “It gave the Black nurses a bigger and better opportunity to live comfortably.”

Allen, now 91, spent 10 years at Seaview and worked on the pediatric ward.

“Administrators, at that time, wanted young women. They were unmarried. They could work long hours. They had no obligations to anybody but their job,” said Maria Smilios, author of “The Black Angels.” “I mean, these women had like 20 patients each, which is huge. And the average care for to take care of somebody with tuberculosis could be 180 minutes.”

Smilios’ book is set to be published in the fall.

“The nurses had to keep daily logs of what was going on in the wards. It is page after page of pain and anguish and suffering,” Smilios said. “Virginia loved children. You know, she talked a lot with me about holding them and reading to them.”

At its peak, there were nearly 2,000 patients in the facility, almost double the intended capacity.

“At a time when people were running away, at a time when people were terrified and rightfully terrified, because it was a very dangerous time, they stepped in and had the courage to do the right thing. And they rescued people,” said Stacey Toussaint, a local historian and owner of Inside Out Tours.

Toussaint includes the story of the Black Angels as part of her Black and Women’s History tours. This story marked the first time she met one in person.

“To be able to talk to someone who, as far as I’m concerned, is living history, and be able to be trusted with their story, there’s no greater honor than that,” Toussaint said.

It was at Seaview in 1957 that Dr. Edward Robitzek helped develop one of the drugs credited as a tuberculosis treatment.

“The patients were going through trial and error. The doctors would never have found it, the cure, because the nurses were administered … administering to the patients,” Allen said.

“At the time, these residents and patients were were put on this island to be sort of isolated from and quarantined, if you will. And, I just think the story hasn’t been told or given as much attention as it deserves,” said Matthew Levy, CEO of NYC Health + Hospitals/Seaview.

Seaview closed its doors as a pandemic facility in 1961. Today, it’s a rehabilitation and nursing facility. But the past is still very much alive there. In the surgical pavilion there are rooms filled with original artifacts from the Black Angels era.

“Virginia is an angel, a real life angel. And, really, everything we do every day sort of harkens back to her ability and love for taking care of people,” Levy said.

“It takes my breath away sometimes to still be here and to be able to talk about it. It’s very, very emotional because I’m speaking for many people, not just myself. But I am proud and happy that I am able to do it,” Allen said.

Allen still lives on the grounds in the former nurses dormitory, which has been converted into senior housing.

Hayley Hodson had Olympic dreams from a young age. 

“Without a doubt, an Olympic gold medal,” Hodson told CBS News.

Hodson excelled as a star volleyball player at Stanford, but she suffered a concussion at practice during what her coaches called the “courage” drill.

“It really felt like target practice,” Hodson said. “And I was the target.”

Hayley said less than two weeks later she took another ball to the head, in almost the same spot.

“The rest of the season is frankly a blur,” Hodson said. “It was so far beyond, like, pain or, like, a sadness, I was like, ‘I’m not functional.'”

A CBS News investigation has examined a gender gap when it comes to research about injured players. The majority of research about the effects of concussions on athletes is based on men, which may be leaving women without the care they need.

A study in the journal Research in Sports Medicine published in 2021 found that the number of young female athletes treated for concussions has tripled in the last twenty years. However, 80% of sports concussion research has focused on men, according to a 2022 study published in the British Journal of Sports Medicine.

“It’s not always the obvious instances that you see, where a concussion occurs,” said Briana Scurry, who won gold medals in both the 1996 Atlanta Olympics and the 2004 Athens Olympics for the U.S. Women’s National Soccer Team.

Scurry said that it was a knee directly to her temple during a 2010 game in Philadelphia that sent her career— and her life — into a tailspin.

“I had these headaches that were streaming from behind my left ear every day for three years,” Scurry said.

She was declarative when asked if enough is known about concussions in women’s sports.

“Absolutely not,” she replied.

“Your daughter is more likely to get a concussion playing soccer than your son is,” cognitive neuroscientist Dr. Chris D’Lauro told CBS News. “But 80% of the data is from male patients who are more like your son.”

D’Lauro co-authored last year’s study in the British Journal of Sports Medicine. That study found that “women are more likely to receive a concussion than male athletes playing the same sport.”

“If we’re gonna take care of our athletes, we need to get information to equip all of our physicians, our coaches, our administrators to make sure that they feel empowered to take care of their own brains,” D’Lauro said. 

Millions in the U.S. could currently be at risk of consuming toxic material through their drinking water, according to a new survey released by the Environmental Protection Agency. The report found there are more than 9 million lead service lines – known to be a “significant source” of lead contamination – used to carry drinking water to homes throughout the nation.

The Drinking Water Infrastructure Needs Survey and Assessment, conducted in 2021 as part of requirements under the Safe Drinking Water Act, looked at more than 3,600 public water systems across the country and its territories. Based on those results, EPA officials estimate that there are roughly 9.2 million lead service lines in the U.S. 

Every state has at least a few thousand lead pipes, but two states stand out for their estimated numbers. Florida leads the nation with an estimated 1.16 million lead pipes, accounting for 12.62% of the country’s total makeup. Illinois ranks second, with a little over 1 million pipes. 

Lead pipes are known to pose a health hazard to those who rely on them for water, and are “typically the most significant source of lead in the water,” according to the EPA. 

“In homes with lead pipes that connect the home to the water main, also known as lead services lines, these pipes are typically the most significant source of lead in the water,” the EPA says, adding that it’s believed no amount of lead contamination can occur without health effects. 

“Lead is a toxic metal that can be harmful to human health even at low exposure levels,” the agency said. “Lead is persistent, and it can bioaccumulate in the body over time.” 

Children, babies and fetuses are most at risk of being impacted by lead exposure, with even low levels being linked to nervous system damage, learning disabilities, hearing impairment and other complications. Adults who are exposed could see cardiovascular, kidney and reproductive problems. 

The Biden administration announced in 2021 that it will use $15 billion from the bipartisan infrastructure bill to replace all of the lead water pipes in the country within the decade. Vice President Kamala Harris said at the time of the announcement that “there is no reason” millions of people should still be exposed. According to the White House, as many as 10 million homes rely on lead service pipes and 400,000 schools and child care facilities are also at risk of exposure. 

Based on their findings, the EPA estimated that the nation will need $625 billion to revamp drinking water infrastructure, a 32% increase from the estimate determined in their last assessment four years prior. More than half of that money will need to go toward water distribution and transmission, the agency said. 

With the release of the EPA’s findings, the White House has already announced funding for states to improve their respective situations. In all, $6.5 billion will be provided to states for drinking water infrastructure upgrades, the White House said, with nearly $3 billion of that money going to “lead service line identification and replacement.” 

Florida – the state with the most lead lines in the nation – will receive more than $376 million, and Illinois will receive $332 million. 

“Every community deserves access to safe, clean drinking water,” EPA Administrator Michael Regan said in a press release. “…We have an unprecedented opportunity to revitalize America’s drinking water systems, support the Biden-Harris Administration’s goal of removing 100% of lead pipes across our country, and protect communities from PFAS pollution.”

Last month, the EPA proposed for the first time a set of national standards for some per- and polyfluorinated substances (PFAS), known as “forever chemicals” because of the significant amount of time it takes for them to break down. If approved, the standards would apply to six of the thousands of manmade PFAS, which have been linked to serious health issues, including cancer. 

“EPA’s proposal to establish a national standard for PFAS in drinking water is informed by the best available science, and would help provide states with the guidance they need to make decisions that best protect their communities,” Regan said. “This action has the potential to prevent tens of thousands of PFAS-related illnesses and marks a major step toward safeguarding all our communities from these dangerous contaminants.”

Ukrainian soldier arrives in New York for surgery on legs wounded in war

Retired businessman Gary Wasserson had never worked in the nonprofit world, but today he calls himself a humanitarian. 

The 67-year-old former telecommunications industry executive from Philadelphia is in the midst of a full-fledged second act that began in 2022 after Russia launched an all-out attack on Ukraine. When Wasserson’s wife made him aware they had relatives in Ukraine, he didn’t miss a beat. In March 2022, he flew to Poland, where he assembled a network to help extract his relatives and other Ukrainians from their war-torn home country, in true grassroots fashion. 

He has since relied on what he calls a “team of angels,” made up of professionals and volunteers to extract hundreds more Ukrainians. His efforts have also expanded beyond bringing relatives and strangers to safety to helping wounded Ukrainians receive prosthetics and more. 

In Ukraine, through a videographer friend of his daughter’s documenting the war, he was also connected to Vladyslav Orlov, a special operations Ukrainian soldier who in October had been severely injured by a Russian explosive device.

“My experience was a very bad experience. I was blown up by Russians — something blew up in my car,” Orlov, 27, told CBS News. “I was stuck in the car and my teammates helped me out. I lost a little piece of my left foot and both of my legs were broken,” he explained.

Orlov received immediate care on the front lines and at two different hospitals in Ukraine that he credits with saving his life. But it quickly became clear that he would require extensive surgical and reconstructive work, plus skin grafts, to eventually regain full use of his limbs. That’s when Wasserson stepped in. 

Finding a hospital

Wasserson called the Hospital for Special Surgery in New York, ranked as the top orthopedic hospital in the U.S. and a leader in trauma care, where his wife had previously undergone back surgery. He asked if it would take on Orlov’s case. 

“They didn’t even say, ‘Let me see.’ They said, ‘Absolutely, if his case is something we can treat, we want him here as soon as possible,'” Wasserson told CBS MoneyWatch.

A team of surgeons at HSS, including orthopedic trauma surgeon Dr. Duretti Fufa, reviewed Orlov’s x-rays and other medical records remotely to evaluate the scope of his complex bone and soft tissue injuries as well as open skin wounds.  

“They reached out to me given the soft tissue injuries, and I agreed we’d be able to help in this case,” Dr. Fufa told CBS MoneyWatch. 

She emphasized that the initial care Orlov received in Ukraine, including surgeries to the tibia and fibula bones in both of his legs, was critical to saving his life and limbs. “He had limb-saving surgeries in Ukraine, and had he not had surgery by their skilled surgeons there, he would not have been able to keep legs.”

Orlov’s girlfriend, Ashley Matkowsky, an American documentary filmmaker whom he met in Ukraine during the war, was also instrumental in helping ensure that he got the necessary care.

“She compiled his records from physicians who treated him at both a government and private hospital, and we liaised with her,” Dr. Fufa said. 

Wasserson also reached out to a United Airlines board member, who arranged for the airline to cover the cost of Orlov’s flights to the U.S.

Funding 100% of the care

At HSS, Orlov has already undergone a number of procedures, from which he is currently healing. In Ukraine, it was unclear if he’d be able to keep his legs. Today, thanks to HSS, it looks increasingly like they will someday be fully functional again, according to Fufa. He is currently recovering from his surgeries; his medical team is monitoring him and will evaluate his condition once his bones heal.  

HSS is covering the cost of all of Orlov’s medical care, while Wasserson is sponsoring him under the U.S. Citizenship and Immigration Services’ Uniting for Ukraine program. It allows Ukrainians to come to the U.S. for two years, provided that they have a supporter in the states to claim financial responsibility for them.

“I have agreed to take full responsibility for any financial issues related to his housing, health care, all of that,” Wasserson said of Orlov, who currently resides in an HSS-owned living unit in New York City. 

His medical care and housing expenses are being paid for through HSS’s charity care program, according to Laura Robbins, senior vice president, Education Institute & Global Affairs at HSS.

“When these cases come to us, we evaluate them make a determination as to whether we can treat them,” she told CBS MoneyWatch. “And we commit to funding 100% of their care.” 

“A key part of why people will seek out HSS is because of the clinical expertise to do the things they did with Orlov, which is take a shot at trying to save his legs,” Robbins said. “We’re known in the trauma world for really having the expertise and experience to say, ‘Wait a minute, maybe we can save this gentleman’s legs, which is what they’re trying to do.'”

“You can get almost anything done”

As Orlov recovers, Wasserson’s efforts to help Ukrainians escape the war continue. U.S. Rep. Susan Wild, a Democrat from Pennsylvania, recently honored Wasserson at the U.S. House of Representatives. 

“He has helped build an entire support network coming to the aid of Ukrainians in need, assisting in the successful extractions of thousands of Ukrainians to safe havens in Poland, Slovakia, Moldova and across Western Europe,” she said. 

Wasserson said he’s working more now as a retiree than when he was employed. 

“I am busier now than when I was working full-time because then, it wasn’t lives — it was profits and losses, it was balance sheets. This is a whole different ball game,” he said. “In business, the urgency is always there to get the best results for your shareholders. But this is a stakeholder issue that is unparalleled to anything I have ever done in my life.”

Ultimately, he chocks up his ability to make a difference to the network he’s been building over the past 12 months. 

“It’s like any other business. People ultimately make the difference, and if you know how to network properly you can get almost anything done in the world,” Wasserson said. “You need a lot of common sense.  If you don’t have the ability to understand what buttons to push to make things happen, you’re going to go in circles.”

Dr. Sara McLin thought she made the right choice by going to an in-network emergency room near her Florida home after her 4-year-old burned his hand on a stove last Memorial Day weekend.

Her family is insured through her husband’s employer, HCA Healthcare, a Nashville-based health system that operates more hospitals than any other system in the nation. So McLin knew that a nearby stand-alone emergency room, HCA Florida Lutz Emergency, would be in their plan’s provider network.

But McLin said a doctor there told her she couldn’t treat her son, Keeling, because he had second- and third-degree burns that needed a higher level of care. The doctor referred them to the burn center at HCA Florida Blake Hospital, about a 90-minute drive away.

McLin, who is a dentist, said the doctor told her the stand-alone ER would not charge for the visit because they did not provide treatment.

“I don’t remember exactly how she phrased it. But something along the lines of, ‘Well, we won’t even call this a visit, because we can’t do anything,'” McLin said.

At Blake Hospital, she said, a doctor diagnosed Keeling with a second-degree burn, drained the blisters, bandaged his hand, and sent them home with instructions on how to care for the wound.

“I didn’t think anything more of it,” McLin said.

Then the bills came.

The Patient: Keeling McLin, now 5, is covered by UnitedHealthcare through his father’s employer.

Medical Service: From the stand-alone emergency room, none. A physician assessed Keeling and sent him to another facility for treatment. “Keeling needs a burn center,” the doctor wrote in the record of his visit.

Service Provider: Envision Physician Services, which employed the emergency room physician at HCA Florida Lutz Emergency in Lutz, Florida, near Tampa, and HCA Florida Trinity Hospital, the main, for-profit hospital to which the stand-alone emergency room belonged.

Total Bill: For the emergency room visit, Envision Physician Services billed $829 to insurance and about $72 to the family. HCA Florida Trinity Hospital billed Keeling about $129, noting it had applied an “uninsured discount.” An itemization showed the original charge had been nearly $1,509 before adjustments and discounts.

What Gives: The stand-alone emergency room and ER doctor, who saw Keeling but referred him to another hospital, billed for his visit. But McLin soon learned she was unable to dispute some of the charges — because her young child’s name was on one of the bills, not hers.

Months after the ER visit, McLin received a bill addressed to the “parents of Keeling McLin” from Envision Physician Services, the provider staffing service that employed the emergency room doctor who did not treat her son. She recalled the doctor’s promise that they would not be billed. “I should have made them write something down to that effect,” she said.

She said she called her insurer, UnitedHealthcare, and a representative told her not to pay the bill.

She received an insurance statement that identified the bill from Envision’s doctor — an out-of-network provider working in an in-network emergency room — as a “surprise bill” for which the provider may charge only copays or other cost-sharing under federal law. McLin said she had not heard anything since then about the bill.

After being contacted by KHN, Aliese Polk, an Envision spokesperson, said in an email that Envision would waive the debt, apologizing to Keeling’s family “for the misunderstanding.”

She described the ER doctor’s evaluation, determination, and referral as a medical service. She said the bill was for cost sharing for the visit — not the difference between what the doctor charged and what insurance paid, as the law prohibits.

“We recognize the patient’s family may have understood at the time of treatment that there would be no charge for the visit, including the medical service provided by our physician,” Polk said. “Unfortunately, this courtesy adjustment was not captured when the claim was processed.”

Maria Gordon Shydlo, a UnitedHealthcare spokesperson, said the insurer believed the matter had been resolved and did not follow up on requests for an interview, even after McLin waived federal health privacy protections, which would allow the insurer to speak to the reporter about the case.

McLin also received a bill from HCA Florida Trinity Hospital for its stand-alone ER at Lutz and decided to dispute the charges.

But after calling the hospital to appeal, McLin said, the billing department would not discuss the debt with her because the statement was in her young son’s name.

“They had him as the guarantor,” McLin said. Unlike Envision, which billed Keeling’s parents and their insurance, McLin said the hospital listed the child as “unemployed, uninsured.”

The child’s ER record also included his date of birth and doctor’s notes referencing his age. McLin said she wrote to HCA in November asking to appeal the bill and that a billing representative told her over the phone that it would put the debt on hold and review the dispute.

“I never heard anything back and assumed we were good,” McLin said.

Then, in January, she received a letter from Medicredit, a collection agency and an HCA subsidiary, stating that Keeling owed $129 and that he had until mid-February to contest the debt. KHN was unable to make contact with Medicredit representatives, and HCA Healthcare did not respond to requests for comment from its subsidiary.

Once again, Sara McLin’s name was not on the debt collector’s letter, and she said Medicredit representatives refused to discuss the debt with her because it was in her son’s name. She said she called HCA, too. “They said, ‘We can’t help you. We don’t have the case anymore,'” she said.

Erin Fuse Brown, a law professor and director of the Center for Law, Health & Society at Georgia State University, said McLin did everything right and that it is unusual for a parent to be barred from discussing a debt related to their minor child.

“The fact that the hospital wouldn’t even talk to her strikes me as the part that is absurd. It’s absurd as a business matter. It’s absurd as a privacy matter,” Fuse Brown said, adding that federal health privacy laws allow a parent or legal guardian to access their dependent’s medical information.

Fuse Brown said the hospital should have been able to correct the error quickly with more information, such as a birth certificate or other document establishing that McLin was Keeling’s parent. At the very least, she said, it could have given McLin notice before sending the bill to collections.

“You get the feeling that it’s this large, automated process, that there’s no human to get through to, that there’s no human to talk to and override the mistake,” Fuse Brown said. “Maybe it’s routine, but she couldn’t even talk to someone to correct a correctable billing error, and then the system just steamrolls over the patient.”

The Resolution: When the collection agency’s deadline passed without resolution, McLin said she felt frustrated. “Nobody can explain to me who has to approve talking to me,” she said. “I don’t know who that person is or what the process is.”

After KHN contacted the health system, HCA Healthcare canceled the family’s debt. HCA representatives declined to be interviewed on the record despite also receiving a privacy waiver from McLin.

“We have attempted to contact Mrs. McLin to apologize to her for the inconvenience this has caused her and to let her know that there is a zero balance on the account,” Debra McKell, marketing director for HCA West Florida Division, said in an email on March 3. “We also will be sharing with her that we are reviewing our processes to ensure this does not happen again.”

McLin later received a letter from HCA stating that the account had been cleared. She also said she received a call from a customer service representative informing her that the debt had not been reported to any credit agencies.

She said she was pleased, but that patients should not have to struggle to correct a billing error before it is sent to a collection agency and potentially ruins their credit.

“It’s the principle of the thing that’s annoying me at this point,” she said.

The Takeaway: Though the notion of a debt collector pursuing a 4-year-old boy may seem farcical, it happens. When seeking medical care for a minor, it is important for the parent or guardian to ensure their name is listed as the responsible party.

Consumers who find themselves fighting a medical billing error need to “think like a lawyer,” Fuse Brown said, including documenting every interaction with the debt collector, getting any promises in writing, and recording phone calls. (State laws vary about how many parties on a call must give permission to record a conversation.)

Patients do not have to give up once a bill goes to collections, Fuse Brown said. “Once you hear from a debt collector, it’s not like the game is over and you lose,” she said. “Consumers do have rights.”

François de Brantes, a home health company executive and expert on how money flows through the health care system, said that hospital billing errors are not uncommon but that he had never heard of a situation like the one McLin experienced. He called it “puzzling” that HCA would issue a formal claim in a dependent child’s name.

De Brantes said those in a similar situation should also ensure that the collection agency removes any record of a debt against a minor to protect the child’s financial future.

“This stuff happens, where you have children who are improperly billed for stuff that they shouldn’t be billed, and they end up in collection,” he said. “Then the kid finds themselves with a collection record and they can’t get loans in the future, potentially student loans.”

Bill of the Month is a crowdsourced investigation by KHN 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!

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

3 million Pennsylvanians need to renew Medicaid eligibility to continue state-sponsored health insur

For millions of Americans who get medical care under Medicaid, the end of March marks a grim deadline. Starting April 1, states will start removing people from the government health insurance program for the poor, paring rolls that swelled during the pandemic. 

The government estimates that 15 million people — or  roughly 1 in 6 of the 84 million on Medicaid — will be kicked off the program. Here’s why this is happening and what people should know.

What’s happening to Medicaid? 

During the pandemic, the government suspended procedures that would remove people from Medicaid. Before the crisis, people would regularly lose their Medicaid coverage if they started making too much money to qualify for the program, or if they moved out of state or gained health care coverage through their employer. That stopped once COVID-19 hit, causing Medicaid enrollment to grow by 5 million between 2020 and 2022.

The Consolidated Appropriations Act, signed last December as the pandemic continued to ebb, instructed states to restart eligibility checks of every person currently on Medicaid. To stay on the rolls, individuals will have to fill out forms to verify their personal information, including their address, income and household size.

Who is affected?

People in danger of losing Medicaid coverage may have relocated or received an income boost that makes them ineligible. 

“Millions of people, working adults, parents with children, will lose Medicaid when they try to re-enroll,” said Ellen Taverna, associate director of the Together for Medicaid program at Community Catalyst. Of those, she estimated 380,000 are working adults who won’t be eligible for other health coverage because they make too little to qualify for Obamacare subsidies, while making too much to sign up for Medicaid. 

However, many are likely to drop out of the program for administrative reasons, such as not receiving a form they need to fill out to re-verify their income and eligibility.

When are people losing coverage? 

That depends on where you live in.

Some states have already started the disenrollment process. The Associated Press reported that no-longer-eligible Medicaid members could be removed as soon as April in these nine states: Arizona, Arkansas, Florida, Idaho, Iowa, New Hampshire, Ohio, Oklahoma and West Virginia.

But not all ineligible people will be dropped from the program at once, as states have set different timelines for re-checking eligibility of Medicaid patients. Most states are expected to take between nine months and a full year to complete the verification process.

How are states notifying people being about losing Medicaid?

As recently as December, two-thirds of adults in Medicaid households weren’t aware that the program rules were changing, according to a survey from the Robert Wood Johnson Foundation.

“Unfortunately we’re going to see it in real time, with children and people losing coverage simply because people are unaware of what’s happening,” Taverna said. 

“That’s the concern, that people will go without coverage for months and then go through bureaucracy and red tape to have to reenroll.” 

Health care advocates are urging people on Medicaid to update their contact information, including their home address, phone number and email, with the state.

If you rely on Medicaid, states will mail a renewal form to your home. The federal government also requires states to contact you in another way -– by phone, text message or email –- to remind you to fill out the form.

“A text might just grab someone’s attention in a way that would be more accessible,” said Kate McEvoy, executive director of the nonprofit National Association of Medicaid Directors. 

While most states have already used texting for reminders to get a COVID-19 vaccine or attend an upcoming doctor’s visit, sending mass texts on Medicaid eligibility will be new, McEvoy said.

You will have at least 30 days to fill out the form. If you do not fill out the form, states will be able to remove you from Medicaid.

What options do people have if they lose Medicaid?

Some of those who won’t qualify for Medicaid coverage will be able to get health insurance from the  Affordable Care Act’s marketplace for coverage, where private coverage subsidized by federal tax credits can cost as little as $10 a month, depending on a person’s income. 

A special enrollment period for people dropped from Medicaid starts March 31 and will last through July 31, 2024, the Centers for Medicare and Medicaid Services said in January. People who lose Medicaid coverage can submit an application at any time during that period after losing coverage and will have up to 60 days to select their plans, CMS said. 

It noted that consumers don’t need to wait until their Medicaid ends to apply for new coverage, but can start applying 60 days before their Medicaid is scheduled to end. 

Still, coverage through the Obamacare marketplace or through an employer is often vastly different from what Medicaid offers. 

“Even on employer-sponsored plans, copays and out-of-pocket costs may be higher than Medicaid, and that makes it unaffordable,” Taverna said. 

People changing coverage will also need to check that their new insurance plans will still cover their doctors.

What happens to kids enrolled in Medicaid?

More than half of U.S. children receive health care coverage through Medicaid or the Children’s Health Insurance Program. But even if an adult loses Medicaid coverage, it doesn’t mean their kids will. 

Even if you receive a notice that you’re no longer eligible for Medicaid, it’s likely that your child still qualifies for the program or for health care coverage through CHIP. CHIP covers children whose families make too much money to qualify for Medicaid but don’t earn enough to afford private health insurance.

Between 80% and 90% of children will still be eligible for those programs, according to estimates from the Georgetown University Health Policy Institute’s Center for Children and Families.

“When a parent receives a message that they aren’t eligible anymore, they often assume their child is no longer eligible either,” Joan Alker, the center’s executive director, told the Associated Press. “It’s more common to find that the parent is no longer eligible for Medicaid, but the child still is.”

The Associated Press contributed reporting.