Shaw, 56, who has been dependent on opioid painkillers since she injured her back in a fall a decade ago, said in both an interview with KFF Health News and in sworn courtroom testimony that the Tennessee clinic would write the prescriptions only if she first agreed to receive three or four “very painful” injections of another medicine along her spine.

The clinic claimed the injections were steroids that would relieve her pain, Shaw said, but with each shot her agony would grow. Shaw said she eventually tried to decline the shots, then the clinic issued an ultimatum: Take the injections or get her painkillers somewhere else.

“I had nowhere else to go at the time,” Shaw testified, according to a federal court transcript. “I was stuck.”

Shaw was among thousands of patients of Pain MD, a multistate pain management company that was once among the nation’s most prolific users of what it referred to as “tendon origin injections,” which normally inject a single dose of steroids to relieve stiff or painful joints. As many doctors were scaling back their use of prescription painkillers due to the opioid crisis, Pain MD paired opioids with monthly injections into patients’ backs, claiming the shots could ease pain and potentially lessen reliance on painkillers, according to federal court documents.

Now, years later, Pain MD’s injections have been proved in court to be part of a decade-long fraud scheme that made millions by capitalizing on patients’ dependence on opioids. The Department of Justice has successfully argued at trial that Pain MD’s “unnecessary and expensive injections” were largely ineffective because they targeted the wrong body part, contained short-lived numbing medications but no steroids, and appeared to be based on test shots given to cadavers — people who felt neither pain nor relief because they were dead.

Four Pain MD employees have pleaded guilty or been convicted of health care fraud, including company president Michael Kestner, who was found guilty of 13 felonies at an October trial in Nashville, Tennessee. According to a transcript from Kestner’s trial that became public in December, witnesses testified that the company documented giving patients about 700,000 total injections over about eight years and said some patients got as many as 24 shots at once.

“The defendant, Michael Kestner, found out about an injection that could be billed a lot and paid well,” said federal prosecutor James V. Hayes as the trial began, according to the transcript. “And they turned some patients into human pin cushions.”

The Department of Justice declined to comment for this article. Kestner’s attorneys either declined to comment or did not respond to requests for an interview. At trial, Kestner’s attorneys argued that he was a well-intentioned businessman who wanted to run pain clinics that offered more than just pills. He is scheduled to be sentenced on April 21 in a federal court in Nashville.

According to the transcript of Kestner’s trial, Shaw and three other former patients testified that Pain MD’s injections did not ease their pain and sometimes made it worse. The patients said they tolerated the shots only so Pain MD wouldn’t cut off their prescriptions, without which they might have spiraled into withdrawal.

“They told me that if I didn’t take the shots — because I said they didn’t help — I would not get my medication,” testified Patricia McNeil, a former patient in Tennessee, according to the trial transcript. “I took the shots to get my medication.”

In her interview with KFF Health News, Shaw said that often she would arrive at the Pain MD clinic walking with a cane but would leave in a wheelchair because the injections left her in too much pain to walk.

“That was the pain clinic that was supposed to be helping me,” Shaw said in her interview. “I would come home crying. It just felt like they were using me.”

‘Not Actually Injections Into Tendons at All’

Pain MD, which sometimes operated under the name Mid-South Pain Management, ran as many as 20 clinics in Tennessee, Virginia, and North Carolina throughout much of the 2010s. Some clinics averaged more than 12 injections per patient each month, and at least two patients each received more than 500 shots in total, according to federal court documents.

All those injections added up. According to Medicare data filed in federal court, Pain MD and Mid-South Pain Management billed Medicare for more than 290,000 “tendon origin injections” from January 2010 to May 2018, which is about seven times that of any other Medicare biller in the U.S. over the same period.

Tens of thousands of additional injections were billed to Medicaid and Tricare during those same years, according to federal court documents. Pain MD billed these government programs for about $111 per injection and collected more than $5 million from the government for the shots, according to the court documents.

More injections were billed to private insurance too. Christy Wallace, an audit manager for BlueCross BlueShield of Tennessee, testified that Pain MD billed the insurance company about $40 million for more than 380,000 injections from January 2010 to March 2013. BlueCross paid out about $7 million before it cut off Pain MD, Wallace said.

These kinds of enormous billing allegations are not uncommon in health care fraud cases, in which fraudsters sometimes find a legitimate treatment that insurance will pay for and then overuse it to the point of absurdity, said Don Cochran, a former U.S. attorney for the Middle District of Tennessee.

Tennessee alone has seen fraud allegations for unnecessary billing of urine testing, skin creams, and other injections in just the past decade. Federal authorities have also investigated an alleged fraud scheme involving a Tennessee company and hundreds of thousands of catheters billed to Medicare, according to The Washington Post, citing anonymous sources.

Cochran said the Pain MD case felt especially “nefarious” because it used opioids to make patients play along.

“A scheme where you get Medicare or Medicaid money to provide a medically unnecessary treatment is always going to be out there,” Cochran said. “The opioid piece just gives you a universe of compliant people who are not going to question what you are doing.”

“It was only opioids that made those folks come back,” he said.

The allegations against Pain MD became public in 2018 when Cochran and the Department of Justice filed a civil lawsuit against the company, Kestner, and several associated clinics, alleging that Pain MD defrauded taxpayers and government insurance programs by billing for “tendon origin injections” that were “not actually injections into tendons at all.”

Kestner, Pain MD, and several associated clinics have each denied all allegations in that lawsuit, which is ongoing.Scott Kreiner, an expert on spine care and pain medicine who testified at Kestner’s criminal trial, said that true tendon origin injections (or TOIs) typically are used to treat inflamed joints, like the condition known as “tennis elbow,” by injecting steroids or platelet-rich plasma into a tendon. Kreiner said most patients need only one shot at a time, according to the transcript.

But Pain MD made repeated injections into patients’ backs that contained only lidocaine or Marcaine, which are anesthetic medications that cause numbness for mere hours, Kreiner testified. Pain MD also used needles that were often too short to reach back tendons, Kreiner said, and there was no imaging technology used to aim the needle anyway. Kreiner said he didn’t find any injections in Pain MD’s records that appeared medically necessary, and even if they had been, no one could need so many.

“I simply cannot fathom a scenario where the sheer quantity of TOIs that I observed in the patient records would ever be medically necessary,” Kreiner said, according to the trial transcript. “This is not even a close call.”

Jonathan White, a physician assistant who administered injections at Pain MD and trained other employees to do so, then later testified against Kestner as part of a plea deal, said at trial that he believed Pain MD’s injection technique was based on a “cadaveric investigation.”

According to the trial transcript, White said that while working at Pain MD he realized he could find no medical research that supported performing tendon origin injections on patients’ backs instead of their joints. When he asked if Pain MD had any such research, White said, an employee responded with a two-paragraph letter from a Tennessee anatomy professor — not a medical doctor — that said it was possible to reach the region of back tendons in a cadaver by injecting “within two fingerbreadths” of the spine. This process was “exactly the procedure” that was taught at Pain MD, White said.

During his own testimony, Kreiner said it was “potentially dangerous” to inject a patient as described in the letter, which should not have been used to justify medical care.

“This was done on a dead person,” Kreiner said, according to the trial transcript. “So the letter says nothing about how effective the treatment is.”

Over-Injecting ‘Killed My Hand’

Pain MD collapsed into bankruptcy in 2019, leaving some patients unable to get new prescriptions because their medical records were stuck in locked storage units, according to federal court records.

At the time, Pain MD defended the injections and its practice of discharging patients who declined the shots. When a former patient publicly accused the company of treating his back “like a dartboard,” Pain MD filed a defamation lawsuit, then dropped the suit about a month later.

“These are interventional clinics, so that’s what they offer,” Jay Bowen, a then-attorney for Pain MD, told The Tennessean newspaper in 2019. “If you don’t want to consider acupuncture, don’t go to an acupuncture clinic. If you don’t want to buy shoes, don’t go to a shoe store.”

Kestner’s trial told another story. According to the trial transcript, eight former Pain MD medical providers testified that the driving force behind Pain MD’s injections was Kestner himself, who is not a medical professional and yet regularly pressured employees to give more shots.

One nurse practitioner testified that she received emails “every single workday” pushing for more injections. Others said Kestner openly ranked employees by their injection rates, and implied that those who ranked low might be fired.

“He told me that if I had to feed my family based on my productivity, that they would starve,” testified Amanda Fryer, a nurse practitioner who was not charged with any crime.

Brian Richey, a former Pain MD nurse practitioner who at times led the company’s injection rankings, and has since taken a plea deal that required him to testify in court, said at the trial that he “performed so many injections” that his hand became chronically inflamed and required surgery.

“‘Over injecting killed my hand,’” Richey said on the witness stand, reading a text message he sent to another Pain MD employee in 2017, according to the trial transcript. “‘I was in so much pain Injecting people that didnt want it but took it to stay a patient.’”

“Why would they want to stay there?” a prosecutor asked.

“To keep getting their narcotics,” Richey responded, according to the trial transcript.

Throughout the trial, defense attorney Peter Strianse argued that Pain MD’s focus on injections was a result of Kestner’s “obsession” with ensuring that the company “would never be called a pill mill.”

Strianse said that Kestner “stayed up at night worrying” about patients coming to clinics only to get opioid prescriptions, so he pushed his employees to administer injections, too.

“Employers motivating employees is not a crime,” Strianse said at closing arguments, according to the court transcript. “We get pushed every day to perform. It’s not fraud; it’s a fact of life.”

Prosecutors insisted that this defense rang hollow. During the trial, former employees had testified that most patients’ opioid dosages remained steady or increased while at Pain MD, and that the clinics did not taper off the painkillers no matter how many injections were given.

“Giving them injections does not fix the pill mill problem,” federal prosecutor Katherine Payerle said during closing arguments, according to the trial transcript. “The way to fix being a pill mill is to stop giving the drugs or taper the drugs.”

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The amounts represent what Medicaid spent covering the residents’ care when they lived at the Glenwood Resource Center, a state-run facility that closed last summer.

The bills are extraordinary examples of a practice called Medicaid estate recovery. Federal law requires states to try to collect money after some types of Medicaid recipients die. The point is to encourage people to use their own resources before relying on the public program. But some states, including Iowa, are particularly aggressive about the collections, national reports show.

Joy Higgins was stunned by a letter she received a few weeks after her 41-year-old daughter, Kristin, died last May. The letter was written on Iowa Department of Health and Human Services stationery. At the top, in bold letters, it said, “Re: Kristin Higgins.”

“Dear Joy Higgins,” the letter read. “Our sincere condolences to you, as we understand the above person is deceased.”

The letter explained that any money Kristin Higgins left behind would have to be remitted to the state to help repay Medicaid $4,263,148.67. Her family had 30 days to respond.

Joy Higgins, who lives in Council Bluffs, wonders why state debt collectors would send a massive bill to the family of someone like her daughter, who had little income because of a severe developmental disability stemming from a premature birth.

“What are they gaining? That’s my question. Except for kicking someone in the face right after they lost a loved one?” Higgins said.

Kristin Higgins’ only income was a Social Security disability benefit of $1,105 monthly. Most of that went directly to the state institution, where she lived for more than 30 years. Just $50 was set aside monthly as an allowance for personal expenses, according to a state ledger obtained by her family. “They knew exactly how much she had,” her mother said.

When she died, Kristin’s personal account had a balance of $2,239.84. The family put that money toward her funeral, an allowed expense. Nothing was left for the state to take. Higgins said receiving the letter was traumatic even though the family didn’t have to pay the Medicaid bill.

The Higginses have heard about similar attempts to collect from other families, including that of Eric Tomlyn, who died in 2020 at age 29 after spending most of his life at the Glenwood Resource Center.

Shortly after his death, the Tomlyn family received a Medicaid bill of more than $4.2 million. His mother, Susan Tomlyn, was shocked by the letter. “I was like, ‘What? What? Oh my God,’” she recalled.

She filled out a form explaining that the small balance in her son’s personal account had gone toward his funeral. “That’s the last I heard of it,” Tomlyn said.

Supporters of estate recovery efforts say the rules encourage people to pay for their own care before applying for Medicaid, which is mainly intended to help those with little money.

Critics of estate recovery programs say they often target families with little to give. Wealthier families tend to have lawyers who can structure estates in ways that avoid Medicaid repayment demands, the critics note.

Like Higgins, Tomlyn thought her Medicaid recovery bill came from state officials because it was printed on letterhead from the Iowa Department of Health and Human Services. The people who signed the letters identified themselves as being from the “Estate Recovery Program.” But the people who produce such letters work for private contractors hired to collect Medicaid debts, according to Alex Murphy, a spokesperson for the state agency. Their contract requires them to use state stationery.

Murphy said in an email to KFF Health News that such letters are sent after every death of an Iowa Medicaid recipient who was at least 55 years old or who lived in a long-term care facility. He said the letters “request information from family members regarding the deceased person’s assets and expenses,” and the letters note that repayments are expected only from the person’s estate.

Iowa’s Medicaid collections are handled by Sumo Group, a Des Moines company. Its director, Ben Chatman, declined to answer questions, including why the company sent bills to families of people with disabilities who lived most of their lives in state institutions. “I don’t do media relations,” Chatman said.

Sumo Group is a subcontractor of a national company, Gainwell Technologies, which has handled Medicaid collections for several states. In Iowa, the company is paid 11% of whatever it can collect from the estates of Medicaid participants. A spokesperson for Gainwell declined to comment.

Iowa’s Medicaid estate recovery program brought in $40.2 million in the fiscal year that ended last June, up nearly 14% from two years earlier, state records show. That total represents a sliver of the state’s total Medicaid budget, which is expected to hit $9 billion this year.

Nearly two-thirds of Iowa estate recovery cases wound up being closed with no collection of money last fiscal year, according to the state. In cases in which money was recouped, the average amount paid was about $10,000.

Thirty-five Iowa families were granted hardship waivers, which the state allows if an heir’s health or life would be endangered because payment of the Medicaid bill would deprive them of food, clothing, shelter, or medical care. Officials denied an additional 20 requests for hardship waivers.

A 2021 report to Congress estimated states collected more than $700 million annually from Medicaid participants’ estates. That money is shared with the federal government, which helps finance Medicaid. Some states claw back much less than others. Hawaii, for example, collected just $31,000 in 2019, the latest year analyzed in the federal report. Iowa, with about twice as many residents as Hawaii, raked back more than $26 million that year.

Americans aren’t subject to such clawbacks for using any other federal health program, including Medicare, which covers older people of all income levels.

The national group Justice in Aging has helped lead opposition to Medicaid estate recovery programs. Eric Carlson, a California attorney for the group, said the issue usually comes into play after the death of a person who had nursing home care covered by Medicaid. Recovery demands often force survivors to sell homes that are their families’ main form of wealth, he said.

Carlson said he hadn’t previously heard of Medicaid estate recovery bills topping $4 million, like the ones sent to survivors of the two Iowans with disabilities.

He wondered why debt collectors would pursue such cases, which are unlikely to yield any money but could cause anxiety for families. “Of course, if you open up a piece of mail that says you owe millions of dollars, you’re going to think the worst,” he said.

Carlson said he would advise anyone who receives such a letter to respond to it with documentation showing that their loved one’s estate can’t repay a Medicaid debt. “It’s never a good idea to ignore it,” he said. Failure to respond to the bill could lead to continued collection efforts, which could threaten a family member’s finances or property, he said.

Some states have reined in their Medicaid clawback efforts. For example, Massachusetts legislators last year voted to drastically limit their program. This was the second time Massachusetts reduced its Medicaid estate recovery effort, which once was one of the most aggressive in the U.S.

Critics in Congress have also tried to limit the practice.

Rep. Jan Schakowsky (D-Ill.) has twice introduced bills to eliminate the federal requirement that states claw back Medicaid spending from recipients’ estates. Last year’s bill gained 47 Democratic co-sponsors, but it received no support from the Republicans controlling the chamber, and there was no similar bill in the Senate. She plans to try again this year, even though her party remains in the minority.

Schakowsky said in an interview that she’d never heard of Medicaid estate recovery demands reaching millions of dollars, as the Iowa families faced. But demands for hundreds of thousands of dollars are common. For many families, “that’s still impossible” to meet, she said.

Schakowsky hopes that members of Congress from both parties will agree to curtail the program once they realize how much angst it causes their constituents and how relatively little money it returns to the government. “The whole program is ridiculous,” she said.

Her quest could become even tougher if the Trump administration moves ahead with proposals to trim Medicaid spending.

The office of Sen. Chuck Grassley, who is the senior member of Iowa’s all-Republican congressional delegation and has taken leading roles in many health policy debates, declined to comment on the issue.

The Iowa Department of Health and Human Services said it notifies families about the estate recovery process when they apply for Medicaid. Joy Higgins said she doesn’t recall seeing such a notice.

The institution where Kristin Higgins spent most of her life was closed last year after federal officials investigated complaints of poor medical care. But Joy Higgins said her daughter was treated well there overall. “If I had millions in the bank, I’d give it to the state,” she said. “I would. It was worth it.”

Has your family been sent bills for repayment of Medicaid expenses after the death of a loved one who was covered by the program? Click here to tell KFF Health News your story.

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The day after Trump’s inauguration, South Carolina GOP Gov. Henry McMaster asked federal officials to approve a work requirement plan. Ohio Republican Gov. Mike DeWine plans to soon follow suit. Republicans in Congress are eyeing Medicaid work requirements as they seek to slash billions from the federal budget.

But, just as a second Trump administration reignites interest in work requirements, Georgia is proposing to scale back key parts of the nation’s only active program. And Arkansas announced an effort to revive — with fundamental changes — a program that ended after a legal judgment in 2019.

The Georgia and Arkansas proposals, from the only two states to have implemented Medicaid work requirements, reveal the disconnect between rhetoric behind such programs and the realities of running them, said consumer advocates and health policy researchers.

“They recognize that what they did the first time didn’t work,” said Ben Sommers, a Harvard professor and a former health official in the Biden and Obama administrations. “It should be a signal to federal policymakers: Don’t point to Georgia and Arkansas and say, ‘Let’s do that.’”

More than a dozen states had Medicaid work requirement programs approved during Trump’s first administration.

After an expensive and bumpy rollout, Georgia in January posted a draft renewal plan for its Georgia Pathways to Coverage program. The plan removes the requirement to document work every month and to pay premiums. Those key elements — which supporters have argued promote employment and personal responsibility — were never implemented, the state said.

Enrollees would still have to meet the work requirement when they first apply and when they renew each year. The draft plan also expands the group of people who can opt out of work reporting to include parents of children under age 6. A public comment period on the plan is open through Feb. 20.

Arkansas’ latest request to federal officials doesn’t require enrollees to report their work hours. Instead, it proposes checking whether people are working, caregiving, or fulfilling other qualifying activities by using data, which could include income, job history, educational status, whether a child lives at home, and other criteria, said Gavin Lesnick, a spokesperson for the state’s Medicaid agency.

People deemed “not on track towards meeting their personal health and economic goals” won’t be disenrolled but can participate in a “success coaching” program to maintain coverage, according to the state’s proposal. A public comment period on Arkansas’ program runs through March 3.

‘Fundamentally Flawed’

More than 90% of U.S. adults eligible for Medicaid expansion are already working or could be exempt from requirements, according to KFF. Still, several states are quickly moving to restart Medicaid work requirements.

Besides the three states of Arkansas, Ohio, and South Carolina, Iowa and South Dakota are considering similar proposals. Lawmakers in Montana are weighing them as they debate renewing the state’s Medicaid expansion.

This week, House Republicans floated a budget proposal to cut $880 billion from the Energy and Commerce Committee, which oversees Medicaid, the state-federal health insurance program for people with low incomes or disabilities. Before the release of that plan, Speaker Mike Johnson said Republicans were discussing changes to Medicaid that include imposing work requirements.

Supporters of such requirements say Medicaid should be reserved for people who are working.

Right now, it “disincentivizes many low-income families from earning additional income” because they would lose health coverage if they make too much money, said South Carolina Gov. McMaster in his January letter to federal officials. He has argued that a work-reporting requirement is “fiscally responsible” and “will incentivize employment.”

There is no evidence showing such programs improve economic outcomes for people; the requirements don’t help people find jobs, but not having health insurance can keep them from working, health policy researchers say.

The goal of Ohio’s plan is to focus “resources and efforts on those who are engaged with their health choices and independence,” said the state. The plan doesn’t require most individuals to regularly “report activities, fill out forms, or take any action” beyond what is generally required for Medicaid enrollment. Ohio estimates that more than 61,000 people, or 8% of enrollees subject to its measure, would lose Medicaid eligibility in the first year.

Consumer advocates, health policy analysts, and researchers said the scaling back seen in recent work requirement proposals speaks to the challenges of mandating them for public benefits — and could serve as a cautionary tale for Republicans in Washington, D.C., and across the country. The programs can eliminate people from the Medicaid rolls or suppress enrollment, while adding costly layers of bureaucracy, they said.

“As a matter of health policy, work-reporting requirements in Medicaid are fundamentally flawed,” said Leo Cuello, a researcher at the Georgetown Center for Children and Families.

Lessons Learned?

Arkansas got its initial program off the ground in 2018 before a federal judge said it was illegal. Unlike Georgia, the state had already expanded Medicaid. That work-reporting requirement led to more than 18,000 people losing coverage, in part because enrollees were unaware or confused about how to report they were working.

In his ruling that ended the program, Judge James Boasberg said its approval was “arbitrary and capricious” because it failed to address a core goal of Medicaid: “the provision of medical coverage to the needy.”

Arkansas’ latest proposal tries to address a potential legal challenge by suspending, rather than terminating, health coverage through the end of the calendar year for people who don’t meet requirements.

“We have worked to design this amendment taking into account lessons learned from previous work requirements,” said Arkansas Medicaid Director Janet Mann at a press conference in late January announcing the new proposal.

But the requirements are “subjective,” and the difference between suspension and termination isn’t meaningful, said Camille Richoux, health policy director of Arkansas Advocates for Children and Families.

“The impact is the same: You can’t go to the doctor,” she said. “You can’t get your prescriptions filled.”

In Georgia, the Pathways program, launched in 2023, has offered coverage to a small portion of those who would qualify for Medicaid if the state had fully expanded it to all low-income adults, as 40 others have done. With the proposed changes, the state estimates enrollment in Pathways would grow to as many as 30,000 people in the final year of the pilot. The state currently estimates at least 246,000 would become eligible for Medicaid under a full expansion.

About 6,500 people were enrolled in Pathways as of late January, said Grant Thomas, the state’s deputy Medicaid commissioner, in a legislative hearing. According to state officials, the program has cost more than $57 million in state and federal funds through December, with most of that money going toward program administration, not benefits.

“Pathways is doing what it is designed to do: increase access to affordable health care coverage while lowering the uninsured rate across Georgia,” said Russel Carlson, who oversees the state’s Medicaid program as commissioner of the Department of Community Health. The changes to Pathways are an attempt to “improve the member experience” while finding ways “to make government more efficient and accessible,” he added.

Pathways requires that enrollees regularly submit documentation to prove they are working, but the program doesn’t include meaningful measures to help people find work, critics said. People who could be eligible for Pathways have said the whole process is time-consuming due to lengthy questionnaires, a glitchy system for uploading documents, and confusing technical language on the website, according to those working with potential enrollees.

“There’s stuff that sounds good on paper, but when you go to implement it in real life, it’s costly and burdensome,” said Leah Chan, director of health justice at the Georgia Budget and Policy Institute.

So far, Pathways has cost state and federal taxpayers nearly $9,000 per enrollee, largely back-end costs to run the program. States that have expanded Medicaid spent about $6,500 per enrollee in that group in 2021, according to KFF researchers.

Georgia GOP Gov. Brian Kemp has said he’s committed to his signature health program, but some Republican state lawmakers have shown an openness to consider full expansion.

A group of Democratic senators cited KFF Health News’ reporting last year when they asked the federal government’s top watchdog to investigate Pathways spending.

Even with the proposed changes, some people, including those who work in the informal or gig economy, may not have official records and may be locked out of health coverage, said Laura Colbert, executive director of Georgians for a Healthy Future, a nonprofit consumer health advocacy organization. People caring for older children or aging relatives, older adults who struggle to find work, and those with medical conditions that prevent them from working still wouldn’t qualify for health coverage, she said.

“The Pathways program just doesn’t reflect the reality of how people are working,” Colbert said. “Pathways is a program that has clearly been developed by people who have had salaried jobs with predictable incomes.”

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Here are some of our favorites, starting with the grand prize winner, whose entry was turned into a cartoon by staff illustrator Oona Zenda. 

1st Place

Runner-Up

What to make for my valentine?Maybe a cake on which we can dine!But raw milk and flu-ish eggs won’t do.Perhaps some fluoridated water in lieu?

– Holly Ainsworth 

Other Newsroom Favorites 

Measles are red.Chickenpox is too.Let’s stick with vaccinesAnd fight covid and flu.

– Arielle Levin Becker 

The donut hole is closed, my dear;Our Part D costs are capped.Let’s hope our love survives alongsideThe Inflation Reduction Act. 

– Brandy Bauer 

My love for you is like health care as a percentage of GDP. It grows larger every year.

– David Schleifer 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Pero eso se acabó en diciembre cuando Mark Newberry se jubiló.

Para atraer a un nuevo médico, los líderes de Havana publicaron anuncios clasificados en los periódicos locales, avisos en las redes sociales y llegaron a un atractivo acuerdo con un consultorio médico libre de renta equipado con una máquina de rayos X, una máquina de ultrasonido y un escáner para medir la densidad ósea, todo propiedad de la ciudad.

Los líderes locales esperan que la campaña de reclutamiento ayude a atraer candidatos en medio de una escasez nacional de médicos.

“Esto es importante para nuestra comunidad”, dijo Kendrah Wilkerson, administradora de Havana, “de la misma manera que los parques son importantes y una buena planificación futura es importante”.

Según un informe del Departamento de Salud de Florida, la escasez de médicos afecta a la totalidad o a parte de casi todos los condados, pero los menos poblados, como Gadsden, donde se encuentra Havana, tienen el menor número de médicos por cada 10,000 habitantes.

Se espera que la escasez de médicos en Florida aumente en la próxima década, y un estudio prevé una necesidad de 18.000 médicos en todo el estado, incluidos 6.000 de atención primaria, para 2035.

“Es un problema enorme”, señaló Matthew Smeltzer, socio de Capstone Recruiting Advisors, una empresa que ayuda a hospitales, consultorios médicos y otros empleadores a encontrar y contratar doctores. “Probablemente, los pueblos pequeños son los más afectados, simplemente porque la mayoría de las personas prefiere vivir en una comunidad mediana o grande”.

En este entorno desafiante, los líderes de Havana esperan que los anuncios y las ventajas de renta gratuita hagan que su pueblo llame la atención y poder atraer a un médico.

Wilkerson describe a la comunidad, situada junto a la frontera sur de Georgia, como un lugar ideal para formar una familia. Sus caminos rurales están bordeados de iglesias, granjas y prados. La calle principal del pueblo tiene tiendas de antigüedades, de regalos, almacenes y restaurantes.

“Todo lo que te imaginas de una película de Hallmark es un poco lo que tenemos aquí”, afirmó Wilkerson. “Las personas todavía se preocupan por los demás y se cuidan, y los vecinos son realmente amigos”.

Ofreciendo generosos incentivos fue como los líderes de la municipalidad consiguieron que Newberry comenzara a ejercer en Havana, en 1993. La ciudad le dio a Newberry un trato inicial similar al que ofrece ahora, y más tarde comenzó a proporcionarle unos $15.000 al año en apoyo financiero.

Newberry, que atendió a unos 2.000 pacientes, no quiso que lo entrevistaran. “¡Me estoy jubilando!”, escribió en un correo electrónico, y agregó que “el pueblo ha elegido formas poco convencionales” de contratar a un médico.

Al subvencionar el consultorio y el uso de equipos médicos para atraer a un médico, Havana está velando por las necesidades de sus residentes, añadió Wilkerson.

Al perder a su médico local, algunos de los antiguos pacientes de Newberry tienen que viajar a Tallahassee, a unos 30 minutos en coche al sureste de Havana. Otros ven a médicos en Quincy, a unos 20 minutos en coche al oeste.

“Esperamos que vuelvan cuando encontremos un nuevo médico”, dijo el alcalde de Havana, Eddie Bass.

Susan Freiden, ex administradora de la municipalidad que se jubiló en 2006, señaló que tener un médico local también es importante para satisfacer las necesidades de los residentes de bajos ingresos, muchos de los cuales son adultos mayores. “No todo el mundo puede ir a Tallahassee para ver a un médico”, dijo. “No todo el mundo tiene transporte”.

Pero queda por ver si toda la oferta es suficiente para atraer a un médico a Havana. La campaña de reclutamiento ha despertado mucho interés entre las enfermeras, pero pocos médicos de atención primaria han solicitado el puesto.

Los líderes del pueblo dicen que no pierden la esperanza de encontrar un médico de familia, que pueda ejercer y recetar medicamentos de forma independiente.

“Realmente preferiríamos tener un médico de verdad que pueda ocuparse de todo esto por nosotros”, afirmó Bass.

Smeltzer, el caza talentos de médicos, apuntó que los médicos de atención primaria son especialmente escasos. Y aunque, según su experiencia, Florida, Carolina del Norte, Tennessee y Texas se encuentran entre los lugares donde los médicos quieren vivir y trabajar, a menudo se necesita algo más para persuadirlos de que trabajen en un pequeño municipio, dijo.

“Si alguien quiere ejercer en un pueblo pequeño, es más probable que vaya a donde tenga vínculos, ya sean ellos mismos o su cónyuge o pareja”, apuntó.

Smeltzer dijo que el reto para una comunidad del tamaño de Havana es que “puede que, literalmente, no haya nadie de ese pueblo que haya ido a la facultad de medicina. O, si lo hay, tal vez sea uno. Pero, ¿era médico de atención primaria?”.

Aun así, hay esperanza. Smeltzer señaló que los médicos jóvenes están dando mucha importancia al equilibrio entre la vida laboral y la personal, y la relación con el paciente, cualidades que pueden dar ventaja a una consulta independiente en un pueblo pequeño.

“Hemos oído hablar de la calidad de vida y del equilibrio entre la vida laboral y la personal mucho más en los últimos tres o cinco años que nunca antes”, agregó, “y eso va casi de la mano con la compensación en cuanto a lo que buscan”.

Freiden, la ex administradora de Havana, dijo que esos son los mismos valores que tenía Newberry cuando comenzó a ejercer aquí. Ella mismo se convirtió en una de sus pacientes.

“Era perfecto”, señaló, “porque no todo era dinero, como puedes imaginar. Era un médico diferente”.

Afortunadamente para Havana, la ciudad ha despertado recientemente el interés de un médico de familia que creció aquí, estudió medicina y espera terminar una residencia de tres años en el Tallahassee Memorial HealthCare en junio.

Camron Browning, graduado en 2003 de la escuela secundaria Northside Havana, declaró ante el Consejo Municipal de siete miembros, en diciembre, que se estaba especializando en medicina familiar y que, durante su residencia, había visto a miles de pacientes, asistido partos y adquirido experiencia como médico de hospitalización.

“Mi objetivo”, dijo, “es poder volver a casa y servir a mi pueblo natal”.

Smeltzer indicó que los incentivos de Havana podrían ser atractivos para los nuevos médicos como Browning, que se enfrentarían a unos costos iniciales desalentadores para establecer una consulta independiente.

Tras la entrevista de diciembre, el Consejo votó por unanimidad iniciar las negociaciones del contrato con Browning, quien dijo que tenía previsto estar listo para atender a los pacientes lo antes posible tras completar su residencia.

“Estoy aquí para quedarme”, dijo Browning al Consejo. “Este siempre fue mi sueño”.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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A California bill awaiting its first hearing would subject drug industry intermediaries known as pharmacy benefit managers, or PBMs, to licensing by the state Department of Insurance. And it would require them to pass along 100% of the rebates they get from drug companies to the health plans and insurers that hire them to oversee prescription drug benefits.

But the proposal, which would impose some of the toughest PBM regulations in the nation, faces at least one major hurdle: Newsom. He vetoed a similar measure last year, unconvinced it would lower consumer costs. He signaled his intent to offer an alternative but has yet to reveal it.

Any fight over PBM reform promises to be a pricey one. Interest groups on both sides spent at least $7 million combined lobbying California lawmakers and the Newsom administration on health care last year, according to records filed with the secretary of state.

“This bill directly threatens the profitability of PBMs going forward,” said Ge Bai, a health policy professor at Johns Hopkins University who has tracked similar bills in other states. “These bills are really the result of an interindustry dog fight, and these are ridiculously fierce fights because PBMs control revenue for pharmacies, as well as for manufacturers.”

The country’s top three PBMs —CVS Caremark, affiliated with Aetna; UnitedHealth Group’s Optum Rx; and Express Scripts, owned by Cigna — control roughly 80% of prescriptions in the United States, according to the Federal Trade Commission. In theory, they leverage their buying power to extract steep discounts from drug manufacturers and pass savings along to insurance companies and employers who provide health coverage.

But as prescription drug prices continue to spiral and federal efforts to control them stall, state lawmakers are focusing on PBMs, which help insurers decide which drugs their plans cover and how much patients will pay out-of-pocket to get them. However, they have been stymied by the drug industry’s secretive ecosystem of rebates, reimbursements, and obscure fees, thwarting efforts to lower drug costs.

In addition to California, PBM proposals have been introduced this legislative session in Arkansas, Iowa, and at least 20 other states as of Feb. 10, according to the National Academy for State Health Policy. All 50 states and Washington, D.C., have some sort of PBM regulation on the books.

And although President Donald Trump has criticized PBMs and vowed to “knock out the middleman,” his recent actions undoing moves to lower prescription drug prices have left some health care experts skeptical that meaningful reform will come from Washington, D.C.

Meanwhile, state data shows California health plan drug costs have grown by more than 50% since 2017. California insurers spent 11% more on pharmaceuticals in 2023 than in 2022, with specialty and brand-name drugs driving the increase.

Both Newsom and bill author Sen. Scott Wiener (D-San Francisco) have said PBMs play a role in high drug prices. While Wiener wants to ban some of their practices outright, Newsom has so far taken a more measured approach, calling for more disclosure and pointing to his plan for the state to manufacture its own generic drugs, which has yet to get off the ground.

In vetoing Wiener’s 2024 bill, which passed in a near-unanimous bipartisan vote, Newsom said he was unconvinced that licensing PBMs would improve affordability for patients and instead directed his administration to “propose a legislative approach” to gather more data from PBMs. In a statement, Newsom spokesperson Elana Ross noted that “Big Pharma backed the vetoed bill” and said the Democratic governor, in partnership with the legislature, will take action to address PBMs this year. She declined to elaborate.

In his January budget proposal, Newsom said his administration was “exploring approaches to increase transparency” in the entire drug supply chain, not just PBMs.

Industry representatives say they’re being unfairly targeted with transparency laws and regulations and blame pharmaceutical companies for setting high drug prices.

“The PBM is taking the risk on price variation, and it allows the client to have certainty on what they’re going to be paying,” said Bill Head, an assistant vice president of state affairs for the Pharmaceutical Care Management Association, which represents PBMs. “We’re hired because it works. It saves money at the end of the day.”

He said PBMs pass on more than 95% of the rebates they receive from drugmakers — a number health policy researchers say is hard to verify.

Consumer advocates say drugmakers simply raise their prices to maintain profits and PBMs charge insurers far more for many medicines than pharmacies are paid to actually dispense them, a practice known as spread pricing.

A January report by the Federal Trade Commission found the three biggest PBMs appeared to steer the most profitable prescriptions away from competitors and to their affiliated pharmacies, which they reimbursed at markups exceeding 1,000% for some drugs, including some used to treat cancer, multiple sclerosis, and serious lung conditions. Over a six-year period, the analysis found, those PBMs and their affiliated pharmacies made roughly $8.7 billion in additional revenue by marking up prices on a sample of 51 specialty drugs.

Wiener’s latest bill, SB 41, would ban such markups, as well as spread pricing, and bar PBMs from receiving performance bonuses based on drug rebates. Similar provisions were stripped out of last year’s bill in the final days before its passage.

“These are practices that only PBMs are engaging in and they’re causing harm, reducing consumer choice, increasing drug costs, and it’s time to address them,” Wiener said. “I’m not going to let that idea just evaporate because of one veto.”

Clint Hopkins, who has co-owned Pucci’s Pharmacy in Sacramento since 2016, said he often deals with complaints from frustrated patients who don’t understand drug pricing schemes and restrictions set by pharmacy benefit managers.

He’s had to turn away customers whose drugs can cost him hundreds of dollars in losses each time they’re filled and says spread pricing is helping drive independent pharmacies out of business.

“I’m not asking to be paid more. I am asking to be paid fairly — at cost or above.”

Under current law, California requires PBMs to disclose some information about drug rebates, and other information, to its clients. That data is often labeled as proprietary to the companies, leaving an incomplete picture of the supply chain, said Maureen Hensley-Quinn, a senior program director at the National Academy for State Health Policy.

PBM representatives say pharmacies, insurers, and other actors in the supply chain should have to disclose information about their profits and practices, too.

“You want to look under the hood?” Head said. “We’re open to that, but let’s look under everybody’s hood.”

Bai said lawmakers are likely going after PBMs because insurers are one portion of the supply chain that they have the power to regulate. But she warned such legislation could cost consumers more if drugmakers and pharmacies remain unchecked. A better approach, Bai suggested, would be to bar PBMs entirely from managing benefits for generic drugs, one of their biggest revenue sources.

“In health care, there’s no saint and there’s no villain. Everybody’s trying to make money,” Bai said. “These fights will bring no benefit to patients unless we go to the root.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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“An Arm and a Leg” is collecting stories from listeners about what they’ve done to get the drugs they need when facing sticker shock. 

If you’ve ever faced difficult choices in order to afford your medicine, “An Arm and a Leg” would love to hear about it. If you’re interested in contributing, you can learn more and submit your stories using this form.

Credits

Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Dan: Hey there– 

So, first: Whoa. There is a LOT going on. I’m recording this on January 30th. I’m not gonna try to summarize what the Trump administration has been doing so far on health care — because by the time you hear this, I have no idea what else might have happened. 

Oh boy. We will definitely have a lot to talk about as this year goes on. And in the meantime, all the things we’ve been talking on this show … they are still happening. 

So, we’ve got a project cooking, and I need your help with it. It’s about how freaking much we pay for medicine. And what we can maybe do about it. 

This problem is something that hits a lot of us. A big recent survey asked: Have you skipped a medication in the last year because of cost? A quarter of people answered yes. 

And we know that a ton of people spend all kinds of time and energy trying to make sure they don’t have to go without meds that cost more than they can afford, or go broke paying for them. 

Looking for coupons, haggling endlessly with insurance, ordering drugs from online pharmacies — even pharmacies in other countries. And in some cases, undertaking all kinds of epic adventures. 

One of the very first episodes of this show was about Laura Derrick, of Austin Texas. And how she turned her life upside down in 2011. She had just started a new drug. 

A drug that may have saved her life. And then, almost immediately, two things happened. Thing one: Laura found out what that drug cost. 

Laura Derrick: I was covered by insurance. So this is not what I paid, but the first bill was over $55,000. 

Dan (talking to Laura): And this is for like a month supply

Laura: A month’s supply.

Dan (talking to Laura): And how much was your share of that?

Laura: Um, my share was about $20. 

Dan: And then, thing two: her husband was diagnosed with cancer. Late-stage cancer. He needed intensive treatment, which meant he couldn’t work. Which meant, he was about to lose his insurance. 

And this was before the Affordable Care Act was implemented. If you had a pre-existing condition, and you didn’t get insurance from your job, you basically couldn’t buy insurance. 

So Laura Derrick needed a job. She knew people who were eager to hire her, but there was a catch. 

Laura: My, my daughter’s last year of high school, my son’s last year of college. I left our family with my husband in cancer treatment because the only job they could offer was in Ohio. 

And it offered us an insurance policy with a zero deductible that cost $20 a month for the whole family and covered everything we needed. But it meant I had to be gone for almost a year and a half. 

Dan: That job, by the way, was with Barack Obama’s 2012 re-election campaign. Laura was determined to win — so the ACA could get implemented, so that people, including her — and her family, could get insurance without going quite as far as she did. 

But to say the least, having insurance does not mean having no problems. For some people, getting their meds — it may not mean taking a job far away from family — but fighting with insurance can become a very frustrating part-time job of its own. 

When I talked with Lillian Karabaic, in 2022, she was grinding away: trying to avoid a crushing bill for Enbrel. That’s an expensive rheumatoid arthritis drug she’d been taking for years. 

Lillian is a financial journalist, who teaches financial self-help to millennials. So, as you can imagine, she’s very organized. 

And as we talked about the adventure she was on at that point, she pulled up the time-tracking software she uses:

Lillian Karabaic: Okay, so it has been nine hours and 32 minutes in the past two weeks that I have spent on healthcare admin, which is mostly being on phone calls. 

Dan: What kicked off all those phone calls had been a rude awakening. Literally. From her phone. 

Lillian: I just got all of a sudden a text message from my specialty pharmacy saying that I have a $3,000 co-pay. That’s not a text message that anybody wants to wake up to. 

Dan: When we talked — two weeks and almost ten hours of phone calls after that text message — Lillian was … giving up on getting out of that three-thousand dollar copay. And getting to work on figuring out how to pay it. 

Lillian: But I’m kind of delaying the inevitable at least long enough to apply for a credit card that has a decent point signup bonus. So at least I can get something out of this entire situation. 

Dan: So, yes: We know how tough this can be. Has been. Is. 

I have a feeling you may know a bit about this too. Like, you may not have gotten a text message saying you owe three thousand bucks. 

But you definitely may have been in the situation of asking, “Holy crap, I’m supposed to pay THIS MUCH for my meds? What?” 

— and THIS MUCH could be thousands of dollars, or hundreds of dollars, or 60 dollars. If it’s a lot to you, it’s a lot. And that’s why I want your help: 

If you’ve been in that situation, what have you done? And what did you learn? Maybe you learned a strategy that actually worked for you. Maybe it was, “Man, I learned about a new way I’m getting screwed.” 

However things went — however they’re going: What did you learn that you want other people to know? It doesn’t have to be a big secret. Just something you’d tell a friend about if they asked. 

But I’m pretty sure there are strategies not enough people know enough about. I’m also pretty sure there are new ways we’re getting beat up.

And the more we learn about those, the more we can work together to do something about them. So I’m asking you to share all that with me. 

By the way, I know that you may not be doing this for yourself, for your own meds. You may be doing this for a family member, or maybe you’re a health care worker trying to help a patient — or patients. Or an advocate or a social worker. 

You’ve been working on this? You’ve been learning something the rest of us should know about? I wanna hear about it. I’d love it if you head over to https://armandalegshow.com/drugs/ — and tell me about it. You can keep it brief, or go long. 

That’s https://armandalegshow.com/drugs/. We’ll have a link wherever you’re finding this, and you can just click that. 

And if you HAVEN’T been on an adventure like this- – well, one: Good. I actually would love to hear about that too. I do not mind hearing good news about good people. Not everything has to be a nightmare. 

And I would love it if you passed this request around. Because probably, somebody you know has a story we should hear about. 

Please encourage them to bring that story right here. A story with a lesson or a question. Like, “Can they freaking DO that?!? Is there anything I can do about it? Is there anything SOMEBODY can do about that?” 

Over the next month or two, we’ll dig into everything you bring us. We may call you for more details. And we’ll call some experts to get answers to some of your questions. 

Then, this spring, we’ll start sharing what we learn. The place to bring it is https://armandalegshow.com/drugs/. 

We’ll have a link wherever you’re listening. Along with a link to some resources you might find helpful. Thank you SO much! 

Meanwhile, I’ll catch you in a few weeks with a new episode. Till then, take care of yourself. 

This is An Arm and a Leg, a show about why health care costs so freaking much, and what we can maybe do about it.

An Arm and a Leg February 3, 2025 Season 13, Episode 2 p.5 

An Arm and a Leg is produced by me, Dan Weissmann, with help from Emily Pisacreta and Claire Davenport — and edited by Ellen Weiss. 

Adam Raymonda is our audio wizard. Our music is by Dave Weiner and Blue Dot Sessions. Bea Bosco is our consulting director of operations. Lynne Johnson is our operations manager. 

An Arm and a Leg is produced in partnership with KFF Health News. That’s a national newsroom producing in-depth journalism about health issues in America — and a core program at KFF: an independent source of health policy research, polling, and journalism. 

Zach Dyer is senior audio producer at KFF Health News. He’s the editorial liaison to this show. We are distributed by KUOW, Seattle’s NPR News Station. 

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor.They allow us to accept tax-exempt donations. You can learn more about INN at INN.org. 

Finally, thank you to everybody who supports this show financially. You can join in any time at armandalegshow.com/support/. 

And thanks for listening.

“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to its newsletters. You can also follow the show on Facebook and the social platform X. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

To hear all KFF Health News podcasts, click here.

And subscribe to “An Arm and a Leg” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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“Oh, c…”, dijo Tavis, desconcertando a su cita.

Tavis vive a 35 millas de distancia, en Leavenworth, Kansas, y todavía no había vuelto a Union Station, donde ocurrió el tiroteo masivo. Sintió ganas de llorar. O tal vez fue un ataque de pánico. Levantó un dedo para indicarle a su cita que necesitaba un momento. Fue entonces cuando él entendió lo que estaba pasando.

“Oh, ni siquiera me di cuenta”, dijo, y siguió conduciendo en silencio.

Tavis contuvo las lágrimas hasta que la estación desapareció de su vista.

“Ok…”, dijo en voz alta, mientras pensaba para sí misma, “bien. Ataque de pánico, primera cita”.

Un año después del tiroteo del 14 de febrero que mató a una persona e hirió al menos a 24, los sobrevivientes y sus familias todavía están conmocionados.

Las relaciones se han tensionado. Los padres están preocupados por sus hijos. El generoso apoyo financiero y los buenos deseos que recibieron en los primeros días ya se han agotado. Y tienen sentimientos encontrados sobre el equipo al que siguen vitoreando: mientras los Chiefs avanzaban hacia otro Super Bowl, muchos se preguntaban por qué su amado equipo parecía ni haber advertido lo que todos estaban pasando.

“No puedo creer que los Chiefs no hayan hecho nada por nosotros”, dijo Jacob Gooch Sr., quien recibió un disparo en el pie. El equipo, la fundación de la familia propietaria y la Liga Nacional de Fútbol Americano (NFL) donaron un total de $200.000 a un fondo para sobrevivientes, pero Gooch dijo que nadie de la organización se acercó a su familia, tres de los cuales recibieron disparos.

Lo que les está sucediendo a estas familias no es nada inusual. Muchos sobrevivientes se “paralizan” emocionalmente como un mecanismo de afrontamiento para evitar sentir por completo el trauma que sufrieron. Pero, con el tiempo, experimentan lo que los terapeutas llaman “descongelamiento”, y la intensidad de lo que sucedió puede volver a dominarlos de repente como le pasó a Tavis.

“El trauma nos lleva al pasado”, dijo Gary Behrman, terapeuta que publicó un modelo de intervención en crisis basado en su trabajo con testigos de los ataques del 11 de septiembre en Nueva York.

Las imágenes, los olores, los sonidos, los sabores y el tacto pueden desencadenar flashbacks que apagan el cerebro como un disyuntor sobrecargado. Es una respuesta de supervivencia, el cerebro es un amigo, dijo Behrman.

La clave para la recuperación es ayudar a los sobrevivientes a encontrar formas saludables de manejar esos desencadenantes, cuando estén listos.

Los sobrevivientes se “descongelan” a su propio ritmo. Recuperar el control después de un evento potencialmente mortal es un proceso que puede llevar semanas, meses o años.

Puede ser fácil sentirse olvidado cuando la vida continúa alrededor. Mientras los fanáticos se juntaban en torno a los Chiefs esta temporada, a los sobrevivientes les resultó difícil ver los juegos. Los Chiefs perdieron ante los Philadelphia Eagles en el Super Bowl del domingo 9 de febrero. Philadelphia celebra su propio desfile el viernes 14, exactamente un año después del tiroteo.

“Es una lástima porque todos los demás siguieron adelante”, dijo Jason Barton.

Barton le practicó resucitación a un hombre que ahora cree que era uno de los presuntos tiradores, su esposa encontró un proyectil de bala en su mochila y su hijastra se quemó con las chispas de una bala que rebotó.

“Si hubiéramos estado al otro lado de ese lugar”, dijo. “No nos habría afectado”.

Viaje de regreso a Union Station

Tavis no es la única sobreviviente que se encontró sin querer en Union Station un año después del tiroteo.

Los niños hicieron excursiones a Science City, ubicado dentro de la estación. Las visitas médicas de seguimiento se realizaban a menudo en vecino Hospital Hill. Una cena de octubre organizada para sobrevivientes por un grupo religioso local estaba a menos de una milla de distancia: una joven sobreviviente rechazó la invitación.

Tavis había planeado regresar a Union Station como parte de su proceso de curación. Pensó que iría cuando se cumpliera un año para tener un momento a solas y sentir las emociones que la invadieran.

Tal vez Dios le estaba mostrando que estaba lista al colocarla allí inesperadamente, le dijo su terapeuta. Tal vez. Pero ella no se sentía lista en ese momento. Quiso ver a un terapeuta justo después del tiroteo. Pero no buscó uno hasta julio, después que la United Way local distribuyera la asistencia financiera a los sobrevivientes y aliviara la tensión económica de meses de trabajo perdido y facturas médicas.

Tavis y su pareja en ese momento habían sacado una tarjeta de crédito adicional para cubrir los gastos mientras esperaban la ayuda prometida.

Después de dos meses de visitas, su terapeuta comenzó a preparar a Tavis para la desensibilización y reprocesamiento del movimiento ocular, una técnica para ayudar a los sobrevivientes de traumas. Ahora, sesión por medio, revisa una hoja de recuerdos del desfile, visualizándolos y reprocesándolos uno por uno.

Está nerviosa porque se acerca el año de aniversario. Es el día de San Valentín y le preocupa que sea deprimente.

Decidió invitar a Gooch, su ex pareja, a que la acompañara a Union Station ese día. Con todo lo que han pasado, él entiende. Estaban en el desfile junto con su hijo y los dos hijos mayores de Jacob. Gooch Sr. y su hijo mayor, Jacob Gooch Jr., recibieron disparos.

El trauma cambia quiénes somos

Gooch Sr. no ha trabajado desde el desfile. Su trabajo requería estar de pie durante turnos de 10 horas cuatro días a la semana, pero no pudo caminar durante meses después de que una bala le destrozara un hueso del pie y se le volviera a fusionar lentamente.

Esperaba volver a trabajar en julio, pero su pie no sanó correctamente y tuvo que operarse en agosto, a lo que siguieron semanas de recuperación.

La cobertura por discapacidad se agotó, al igual que su seguro médico a través del trabajo. Su empleador mantuvo su trabajo durante un tiempo antes de despedirlo en agosto. Ha buscado otros empleos en Leavenworth y sus alrededores: producción, agencias de personal, reparación de automóviles. No ha conseguido nada.

“Todos hemos pasado por problemas, no solo yo”, dijo Gooch Sr. “Me dispararon en el pie y no he trabajado durante un año. Hay gente que ha pasado por cosas mucho peores durante el último año”.

Ahora se siente bien al caminar y puede correr distancias cortas sin dolor. Pero no sabe si alguna vez volverá a jugar al fútbol americano, un pilar de su vida desde que tiene memoria. Jugó como safety para los Kansas City Reapers, un equipo semi profesional, y, antes del desfile, el jugador de 38 años estaba considerando que la de 2024 fuera su última temporada como jugador.

“Me han robado mucho más que el fútbol americano en este último año. Como si me hubieran robado toda mi vida”, dijo Gooch Sr. “Realmente odio esa parte”.

Y esas emociones son dolorosamente reales. El trauma amenaza nuestras creencias sobre nosotros mismos, dijo el terapeuta Behrman. Cada persona carga su propia historia a un evento traumático, una identidad diferente que corre el riesgo de ser destrozada. El trabajo de sanación que viene después a menudo implica dar vuelta la página, y construir algo nuevo.

Recientemente, Gooch Sr. comenzó a ir a una nueva iglesia, dirigida por el esposo de alguien con quien cantó en un coro cuando era niño. En un servicio dominical de este mes, el pastor habló sobre encontrar un camino cuando uno está perdido.

“Estoy buscando el camino. Estoy en el campo ahora mismo”, dijo Gooch Sr. en su casa más tarde esa noche.

“Obviamente estoy en un camino, pero no sé hacia dónde voy”.

“Hice lo mejor que pude”

Todos los días antes de que Jason Barton se vaya a trabajar, le pregunta a su esposa, Bridget, si debería quedarse en casa con ella.

Ella ha dicho que sí lo suficiente como para que se le acabara el tiempo libre remunerado. Jason, que ha sobrevivido al cáncer y a un ataque cardíaco, tuvo que tomarse una licencia sin goce de sueldo en enero cuando un caso grave de gripe lo llevó al hospital. Eso es amor verdadero, dijo Bridget con lágrimas en los ojos, sentada con Jason y su hija de 14 años, Gabriella, en su casa en Osawatomie, Kansas.

Bridget se ha conectado con la madre de otra niña herida en el tiroteo. Han intercambiado mensajes de texto y de voz durante todo el año. Bridget dijo que es bueno tener a alguien con quien hablar que entienda. Tienen la esperanza de reunir a las niñas para que también construyan una conexión.

Con excepción de ir a terapia una vez por semana, Bridget ya no sale mucho de casa. Puede sentirse como una prisión, dijo, pero tiene demasiado miedo de salir. “Es mi propio infierno interno”, dijo. No deja de pensar en esa bala que se alojó en su mochila. ¿Qué hubiera pasado si hubiera estado parada de otra manera? ¿Qué hubiera pasado si se hubieran ido 10 segundos antes? ¿Las cosas serían diferentes?

Una nota adhesiva en su cocina le recuerda: “Estoy a salvo. Gabriella está a salvo. Hice lo mejor que pude”.

Siente mucha culpa. Por Jason quedándose en casa. Por no salir de casa, ni siquiera para ver a sus nietos. Por querer que la familia fuera al desfile en primer lugar. Al mismo tiempo, sabe que de alguna manera prosperó en el caos después del tiroteo, haciéndose cargo de su hija, hablando con la policía. Todo es confuso.

La familia ha sobrellevado el trauma de manera diferente.

En los seis meses posteriores al desfile, Jason vio reality shows que lo mantenían distraído: 23 temporadas de “Deadliest Catch” y 21 temporadas de “Gold Rush”, incluidos los spin-offs, según calculó.

Últimamente ha mantenido su mente ocupada con un nuevo pasatiempo: construir modelos de autos y aviones. Acaba de terminar un Shelby Mustang negro de 1968, y lo próximo es un avión F4U-4 Corsair que Bridget le regaló.

Gabriella pudo regresar a Union Station para una excursión escolar a Science City, pero se sobresaltó cuando vio a un grupo de policías dentro de la estación. Su madre veía en dónde estaba por el celular, y le envió mensajes de texto durante todo el día.

Después del desfile, Gabriella comenzó a practicar boxeo, luego se pasó a la lucha libre. Le había ido bien, incluso se sentía empoderada. Pero dejó de ir, y Bridget cree que se debe en parte a la emoción del aniversario: el primero siempre es el más difícil, dijo su terapeuta. Gabriella insistió en que la lucha libre la estaba agotando.

Como no les dispararon, la familia no se benefició de los recursos disponibles para otros sobrevivientes. Entienden que otras familias se están recuperando de heridas de bala o incluso están de luto por una muerte.

Aun así, sería bueno que se reconociera de alguna manera su trauma emocional. Sus nombres han estado en las noticias. Uno pensaría que los Chiefs al menos habrían enviado una carta.

Jason dijo: “Lamentamos que esto te haya pasado”.

Jason le propuso matrimonio a Bridget en un partido de los Chiefs. Ahora, ver los partidos por televisión desencadena recuerdos.

“Quiero volver a ser parte del Reino de los Chiefs”, dijo Bridget, “pero no puedo. Y ese es un sentimiento enorme y muy solitario”.

“Hay una palabra llamada ‘resiliencia’”

Una noche del pasado octubre, los sobrevivientes se reunieron con sus familias en un restaurante mexicano en el centro de Kansas City.

Algunos vinieron vestidos con sus mejores galas, otros con camisetas rojas de fútbol americano. De todas las edades, desde niños pequeños hasta personas de 70 y tantos años, algunos de Missouri, algunos de Kansas. Algunos hablaban solo español, algunos solo inglés. La mayoría de las dos docenas de personas nunca se habían visto antes. Pero mientras hablaban, descubrieron que el tiroteo que los une también les dio un lenguaje común.

Dos niños pequeños se dieron cuenta de que habían lanzado una pelota de fútbol durante el jubileo antes de que estallara la violencia. Una mujer de unos 70 años llamada Sarai Holguín recordó haberlos visto jugar en ese cálido día de febrero. Después de una bendición y una cena, Holguín, que recibió un disparo en la rodilla y ha sido sometida a cuatro cirugías, se puso de pie para dirigirse a la sala.

“Fui la primera víctima que llevaron a la carpa médica”, dijo en español, sus palabras traducidas por un familiar de otro sobreviviente. Ella vio todo, explicó, mientras, uno por uno, más sobrevivientes eran trasladados a la carpa para recibir tratamiento, incluida Lisa López-Galván, una madre de 43 años que fue asesinada ese día.

Sin embargo, en esa tragedia, Holguín vio la belleza de la gente que se ayuda entre sí.

“Esto nos mostró que la humanidad todavía está viva, que el amor todavía está vivo. Hay una palabra que se llama ‘resiliencia’”, dijo Holguín. Mientras el traductor se esforzaba por entender la última palabra, la gente del público la captó y la gritó: “Resiliencia”.

“Esta palabra nos ayuda a superar los problemas que enfrentamos”, dijo Holguín. “Para tratar de dejar atrás el momento trágico que todos vivimos y seguir adelante, debemos recordar los momentos hermosos”.

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Emily Tavis was on a first date in December when she looked up and realized they were driving past the downtown Kansas City, Missouri, intersection where a bullet ripped through her leg at last year’s Super Bowl victory parade.

“Oh f—,” Tavis said, bewildering her date.

She lives 35 miles away in Leavenworth, Kansas, and hadn’t yet returned to Union Station, where the mass shooting happened. She felt like crying. Or maybe it was a panic attack. She held up a finger signaling to her date that she needed a moment. That’s when it hit him, too.

“Oh crap, I didn’t even realize,” he said, and kept driving in silence.

Tavis sucked in her tears until the station was out of view.

“So anyway,” she said aloud, while thinking to herself, “way to go. Panic attack, first date.”

A year after the Feb. 14 shooting that killed one and injured at least 24 people, the survivors and their families are still reeling. Relationships have strained. Parents are anxious about their children. The generous financial support and well wishes that poured through in early days have now dried up. And they’re ambivalent about the team they all root for; as the Chiefs moved on to another Super Bowl, many wondered why their beloved team hasn’t acknowledged what they have all been going through.

“I can’t believe the Chiefs didn’t do anything for us,” said Jacob Gooch Sr., who was shot in the foot. The team, the owner family’s foundation, and the National Football League gave a combined $200,000 to a fund for survivors, but Gooch said no one from the organization reached out to his family, three members of whom were shot.

What’s happening to these families is far from unusual. Many survivors emotionally freeze as a coping mechanism to avoid fully feeling the trauma they suffered. But with time, survivors experience what therapists call “thawing,” and the intensity of what happened can suddenly overpower them like it did Tavis.

“Trauma pulls us into the past,” said Gary Behrman, a therapist who published a model of crisis intervention based on his work with witnesses of the 9/11 attacks in New York.

Sights, smells, sounds, tastes, and touches can all trigger flashbacks that shut down the brain like an overloaded circuit breaker. It’s a survival response, Behrman said; the brain is a friend.

The key to recovery is to help survivors find healthy ways to manage those triggers — when they are ready.

Survivors thaw at their own pace. Regaining control after a life-threatening event is a process that can take weeks, months, or years.

It can be hard not to feel forgotten when life carries on around them. As fans rallied around the Chiefs this season, survivors found it hard to watch the games. The Chiefs lost to the Philadelphia Eagles in Sunday’s Super Bowl. Philadelphia will hold its own parade on Friday, exactly one year after the shooting.

“It sucks because everybody else went on,” Jason Barton said. He performed CPR on a man he now thinks was one of the alleged shooters, his wife found a bullet slug in her backpack, and his stepdaughter was burned by sparks from a ricocheted bullet.

“If we were on the other side of that place, we would too,” he said. “It wouldn’t have affected us.”

A Trip Back to Union Station

Tavis isn’t the only survivor to have found herself unintentionally back at Union Station in the year since the shooting. Kids had field trips to Science City, located inside the station. Follow-up doctor visits were often on nearby Hospital Hill. An October dinner organized for survivors by a local faith-based group was less than a mile away, prompting one young survivor to decline the invitation.

Tavis had planned to return to Union Station as part of her healing process. She thought she would go on the one-year mark to have a moment alone to feel whatever emotions swept over her there.

Maybe God was showing her she was ready by placing her back there unexpectedly, her therapist told her. Maybe. But she didn’t feel ready in that moment.

Tavis wanted to see a therapist right after the shooting. But she didn’t seek one out until July, after the local United Way distributed financial assistance to survivors and relieved the months-long financial strain of lost work and medical bills incurred by many. Tavis and her partner at the time had taken out an extra credit card to cover expenses while they waited for the promised help.

After two months of visits, her therapist started prepping Tavis for eye movement desensitization and reprocessing, a technique to help trauma survivors. She now spends every other session making her way through a spreadsheet of memories from the parade, visualizing and reprocessing them one by one.

She’s nervous as the one-year mark approaches. It’s on Valentine’s Day, and she worries it’ll be depressing.

She decided to invite Gooch, her former partner, to come to Union Station with her that day. Despite everything, he’s the one who understands. They were at the parade together with their son and Jacob’s two older kids. Both Gooch Sr. and his older son, Jacob Gooch Jr., were also shot.

Trauma Changes Who We Are

Gooch Sr. hasn’t worked since the parade. His job required standing for 10-hour shifts four days a week, but he couldn’t walk for months after a bullet shattered a bone in his foot and it slowly fused back together. He hoped to go back to work in July. But his foot didn’t heal correctly and he had surgery in August, followed by weeks of recovery.

His short-term disability ran out, as did his health insurance through work. His employer held his job for a while before releasing him in August. He’s applied for other jobs in and around Leavenworth: production, staffing agencies, auto repair. Nothing’s come through.

“We’ve all gone through problems, not just me,” Gooch Sr. said. “I got shot in my foot and haven’t worked for a year. There are people that have been through much worse stuff over the past year.”

He feels good walking now and can run short distances without pain. But he doesn’t know if he’ll ever play football again, a mainstay of his life since he can remember. He played safety for the semiprofessional Kansas City Reapers and, before the parade, the 38-year-old was considering making the 2024 season his last as a player.

“A lot more than football has been stolen from me in this last year. Like my whole life has been stolen from me,” Gooch Sr. said. “I really hate that part of it.”

And those emotions are painfully real. Trauma threatens our beliefs about ourselves, said Behrman, the therapist. Every person brings their own history to a traumatic event, a different identity that risks being shattered. The healing work that comes later often involves letting go and building something new.

Recently Gooch Sr. started going to a new church, led by the husband of someone he sang with in a children’s choir growing up. At a Sunday service this month, the pastor spoke about finding a path when you’re lost.

“I’m looking for the path. I’m in the grass right now,” Gooch Sr. said at his home later that evening.

“I’m obviously on a path, but I don’t know where I’m headed.”

‘I Did the Best I Could’

Every day before Jason Barton goes to work, he asks his wife, Bridget, if he should stay home with her.

She’s said yes enough that he’s out of paid time off. Jason, who’s survived cancer and a heart attack, had to take unpaid leave in January when a bad case of the flu put him in the hospital. That’s real love, Bridget said with tearful eyes, sitting with Jason and her 14-year-old daughter, Gabriella, in their home in Osawatomie, Kansas.

Bridget has connected with the mother of another girl injured in the shooting. They’ve exchanged texts and voicemails throughout the year. It’s nice to have someone to talk to who gets it, Bridget said. They’re hoping to get the girls together to build a connection as well.

Except for a trip to therapy once a week, Bridget doesn’t leave the house much anymore. It can feel like a prison, she said, but she’s too scared to leave. “It’s my own internal hell,” she said. She keeps thinking about that bullet slug that lodged in her backpack. What if she’d been standing differently? What if they’d left 10 seconds earlier? Would things be different?

A Post-it note in her kitchen reminds her: “I’m safe. Gabriella is safe. I did the best I could.”

She carries a lot of guilt. About Jason staying home. About not leaving the house, even to see her grandkids. About wanting the family to go to the parade in the first place. At the same time, she knows she kind of thrived in the chaos after the shooting, taking charge of her daughter, talking to the police. It’s confusing.

The family has carried the trauma differently. In the six months after the parade, Jason watched reality TV shows that kept him out of his head — 23 seasons of “Deadliest Catch” and 21 seasons of “Gold Rush,” including spinoffs, he estimated. Lately he’s kept his mind occupied with a new hobby: building model cars and planes. He just finished a black 1968 Shelby Mustang, and next is an F4U-4 Corsair plane that Bridget got him.

Gabriella was unfazed about returning to Union Station for a class field trip to Science City, but she was startled when she saw a group of police officers inside the station. Her mom watched her location on her phone and texted her all day.

Gabriella took up boxing after the parade, then switched to wrestling. It had been going well, even felt empowering. But she’s stopped going, and Bridget thinks it’s partly due to the emotion of the anniversary — the first is always the hardest, her therapist said. Gabriella insisted that wrestling was just exhausting her.

Because they weren’t shot, the family didn’t benefit from resources available to other survivors. They understand that other families are recovering from bullet wounds or even mourning a death.

Still, it would be nice to have some acknowledgment of their emotional trauma. Their names have been in the news. You’d think the Chiefs would have at least sent a letter saying, “We’re sorry this happened to you,” Jason said.

Jason proposed to Bridget at a Chiefs game. Now watching games on TV triggers flashbacks.

“I want to be a part of Chiefs Kingdom again,” Bridget said, “but I just can’t. And that is a huge, really lonely feeling.”

‘There Is a Word Called “Resilience”’

One evening last October, survivors gathered with their families at a Mexican restaurant in downtown Kansas City.

Some came dressed in their Sunday best, some in red football jerseys. All ages, toddlers to 70-somethings, some from Missouri, some from Kansas. Some spoke only Spanish, some only English. Most of the two dozen people had never met before. But as they talked, they discovered the shooting that binds them also gave them a common language.

Two young boys realized they’d tossed a football during the jubilation before the violence erupted. A woman in her early 70s named Sarai Holguin remembered watching them play on that warm February day. After a blessing and dinner, Holguin, who was shot in the knee and has had four surgeries, stood to address the room.

“I was the first victim taken to the medical tent,” she said in Spanish, her words translated by a relative of another survivor. She saw everything, she explained, as, one by one, more survivors were brought to the tent for treatment, including Lisa Lopez-Galvan, a 43-year-old mother who was killed that day.

Yet in that tragedy, Holguin saw the beauty of people helping one another.

“This showed us that humanity is still alive, that love is still alive. There is a word called ‘resilience,’” Holguin said, the translator stumbling to understand the last word, as people in the audience caught it and shouted it out. “Resilience.”

“This word helps us overcome the problems we face,” Holguin said. “To try to put the tragic moment we all lived behind us and move on, we must remember the beautiful moments.”

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“Tell them she’s on Eliquis!” said Martin, a nurse who lived an hour’s drive away in Winston-Salem. She knew the blood thinner could lead to life-threatening blood loss.

When the ambulance arrived, the medics evaluated Martin’s aunt and then did something few emergency medical services crews do: They gave her a blood transfusion to replace what she’d lost, stabilizing her sinking blood pressure.

The ambulance took her to the local high school, and from there a medical helicopter flew her to the nearest trauma center, in Winston-Salem. She needed more units of blood in the helicopter and at the hospital but eventually recovered fully.

“The whole situation would have been different if they hadn’t given her blood right away,” Martin said. “She very well might have died.”

More than 60,000 people in the U.S. bleed to death every year from traumatic events like car crashes or gunshot wounds, or other emergencies, including those related to pregnancy or gastrointestinal hemorrhaging. It’s a leading cause of preventable death after a traumatic event.

But many of those people likely wouldn’t have died if they had received a blood transfusion promptly, trauma specialists say. At a news conference last fall, members of the American College of Surgeons estimated that 10,000 lives could be saved annually if more patients received blood before they arrived at the hospital.

“I don’t think that people understand that ambulances don’t carry blood,” said Jeffrey Kerby, who is chair of the ACS Committee on Trauma and directs trauma and acute care surgery at the University of Alabama-Birmingham Heersink School of Medicine. “They just assume they have it.”

Of the more than 11,000 EMS agencies in the U.S. that provide ground transport to acute care hospitals, only about 1% carry blood, according to a 2024 study.

The term “blood deserts” generally refers to a problem in rural areas where the nearest trauma center is dozens of miles away. But heavy traffic and other factors in suburban and urban areas can turn those areas into blood deserts, too. In recent years, several EMS agencies throughout the country have established “pre-hospital blood programs” aimed at getting blood to injured people who might not survive the ambulance ride to the trauma center.

With blood loss, every minute counts. Blood helps move oxygen and nutrients to cells and keeps organs working. If the volume gets too low, it can no longer perform those essential functions.

If someone is catastrophically injured, sometimes nothing can save them. But in many serious bleeding situations, if emergency personnel can provide blood within 30 minutes, “it’s the best chance of survival for those patients,” said Leo Reardon, the Field Transfusion Paramedic Program director for the Canton, Massachusetts, fire department. “They’re in the early stages of shock where the blood will make the most difference.”

There are several roadblocks that prevent EMS agencies from providing blood. Several states don’t allow emergency services personnel to administer blood before they arrive at the hospital, said John Holcomb, a professor in the division of trauma and acute care surgery at UAB’s Heersink School.

“It’s mostly tradition,” Holcomb said. “They say: ‘It’s dangerous. You’re not qualified.’ But both of those things are not true.”

On the battlefields in the Middle East, operators of military medical facilities would maintain that only nurses and doctors could do blood transfusions, said Randall Schaefer, a U.S. Army trauma nurse who was deployed there and now consults with states on implementing pre-hospital blood programs.

But in combat situations, “we didn’t have that luxury,” Schaefer said. Medical staff sometimes relied on medics who carried units of blood in their backpacks. “Medics can absolutely make the right decisions about doing blood transfusions,” she said.

A quick response made a difference: Soldiers who received blood within minutes of being injured were four times as likely to survive, according to military research.

Civilian emergency services are now incorporating lessons learned by the military into their own operations.

But they face another significant hurdle: compensation. Ambulance service payments are based on how far vehicles travel and the level of services they provide, with some adjustments. But the fee schedule doesn’t cover blood products. If EMS responders carry blood on calls, it’s usually low-titer O whole blood, which is generally safe for anyone to receive, or blood components — liquid plasma and packed red blood cells. These products can cost from $80 to $600 on average, according to Schaefer’s study. And payments don’t cover the blood coolers, fluid warming equipment, and other gear needed to provide blood at the scene.

On Jan. 1, the Centers for Medicare & Medicaid Services began counting any administration of blood during ambulance pre-hospital transport as an “advanced life support, level 2” (ALS2) service, which will boost payment in some cases.

The higher reimbursement is welcome, but it’s not enough to cover the cost of providing blood to a patient, which can run to more than $1,000, Schaefer said. Agencies that run these programs are paying for them out of their own operating budgets or using grants or other sources.

Blood deserts exist in rural and urban areas. Last August, Herby Joseph was walking down the stairs at his cousin’s house in Brockton, Massachusetts, when he slipped and fell. The glass plate he was carrying shattered and sliced through the blood vessels in his right hand.

“I saw a flood of blood and called my cousin to call 911,” Joseph, 37, remembered.

The ambulance team arrived in just a few minutes, evaluated him, and called in the Canton-based Field Transfusion Paramedic Program team, which began administering a blood transfusion shortly thereafter. The program serves 30 towns in the Boston area. Since the transfusion program began last March, the team has responded to more than 40 calls, many of them related to car accidents along the ring of interstate highways surrounding the area, Reardon said.

Brockton has a Level 3 trauma center, but Joseph’s injuries required more intensive care. Boston Medical Center, the Level 1 trauma center where the EMS team was taking Joseph, is about 23 miles from Brockton, and depending on traffic it can take more than a half hour to get there.

Joseph was given more blood at the medical center, where he remained for nearly a week. He eventually underwent three surgeries to repair his hand and has now returned to his warehouse job.

Although Boston has several Level 1 trauma centers, the region south of the city is pretty much a trauma desert, said Crisanto Torres, one of the trauma surgeons who cared for Joseph.

Boston Medical Center partners with the Canton Fire Department to operate the field transfusion program. It’s an important service, Torres said.

“You can’t just put up a new Level 1 trauma center,” he said. “This is one way to blunt the inequity in access to care. It buys patients time.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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