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U.S. Suspends Haitian Airlift in Cost Dispute

by Shaila Dewan

MIAMI - The United States has suspended its medical evacuations of critically injured Haitian earthquake victims until a dispute over who will pay for their care is settled, military officials said Friday.

The military flights, usually C-130s carrying Haitians with spinal cord injuries, burns and other serious wounds, ended on Wednesday after Gov. Charlie Crist of Florida formally asked the federal government to shoulder some of the cost of the care.

Hospitals in Florida have treated more than 500 earthquake victims so far, the military said, including an infant who was pulled out of the rubble with a fractured skull and ribs. Other states have taken patients, too, and those flights have been suspended as well, the officials said.

The suspension could be catastrophic for patients, said Dr. Barth A. Green, the co-founder of Project Medishare for Haiti, a nonprofit group affiliated with the University of Miami's Miller School of Medicine that had been evacuating about two dozen patients a day.

"People are dying in Haiti because they can't get out," Dr. Green said.

It was not clear on Friday who exactly was responsible for the interruption of flights, or the chain of events that led to the decision. Sterling Ivey, a spokesman for Mr. Crist, said the governor's request for federal help might have caused "confusion."

"Florida stands ready to assist our neighbors in Haiti, but we need a plan of action and reimbursement for the care we are providing," Mr. Ivey said.

Mr. Crist's request did not indicate how much the medical care was costing the State of Florida, but the number and complexity of the cases could put the total in the millions of dollars. The expenditure comes at a time when the state is suffering economically and Mr. Crist, a Republican, is locked in a tough primary battle for the Senate seat that had been held by Mel Martinez.

"Recently, we learned that plans were under way to move between 30 to 50 critically ill patients a day for an indefinite period of time," Mr. Crist wrote in a letter to Kathleen Sebelius, the secretary of health and human services. "Florida does not have the capacity to support such an operation."

A spokeswoman for the Department of Health and Human Services said the decision to suspend the flights was made by the military, not the federal health department. A military spokesman said that the military had ended the flights because hospitals were becoming unwilling to take patients.

"The places they were being taken, without being specific, were not willing to continue to receive those patients without a different arrangement being worked out by the government to pay for the care," said Maj. James Lowe, the deputy chief of public affairs for the United States Transportation Command.

Florida officials, meanwhile, said the state's hospitals had not refused to take more patients. Jeanne Eckes-Roper, the health and medical chairwoman of the domestic security task force for the South Florida region - where the Super Bowl will be played on Feb. 7 - said she had requested only that new patients be taken to other areas of the state, like Tampa.

The Health and Human Services spokeswoman, Gretchen Michael, who works for the assistant secretary for preparedness and response, said the agency was reviewing Mr. Crist's request for financial assistance. The request would involve activating the National Disaster Medical System, which is usually used in domestic disasters and which pays for victims' care.

Some of the patients being airlifted from Haiti are American citizens and some are insured or eligible for insurance. But Haitians who are not legal residents of the United States can qualify for Medicaid only if they are given so-called humanitarian parole - in which someone is allowed into the United States temporarily because of an emergency - by United States Citizenship and Immigration Services.

Only 34 people have been given humanitarian parole for medical reasons, said Matthew Chandler, a spokesman for the Department of Homeland Security. The National Disaster Medical System, if activated, would cover the costs of caring for patients regardless of their legal status.

Some hospitals have made their own arrangements to accommodate victims of the earthquake, which occurred on Jan. 12. Jackson Health System, the public hospital system in Miami, treated 117 patients, 6 of whom were still in critical condition, said Jennifer Piedra, a spokeswoman. The system has established the Haiti's Children Fund to cover the costs of treating pediatric earthquake victims.

In the aftermath of the earthquake, Haitian medical facilities were quickly overwhelmed. Since then, medical help has come in the form of mobile hospitals and other aid. Major Lowe said that as medical care had become available in Haiti, the need for the flights had declined significantly. But Dr. Green and nonprofit groups with a presence in Haiti said the need for evacuations remained dire.

"Right now we have in the queue dozens of paraplegics, burn victims and other patients that need to be evacuated," Dr. Green said. "And other facilities are asking us to coordinate the evacuation of their patients."

A spokeswoman for Partners in Health, a Boston charity with doctors and nurses in Haiti, said the group had a backlog of patients, many with head, spine or pelvic injuries, who needed surgery that could not be performed there.

Major Lowe said patients could still be evacuated in private planes, but Dr. Green said medically equipped planes were very expensive and generally could carry only one or two patients.

Federal officials could not provide the total number of earthquake patients airlifted to the United States, but Florida seemed to have received the bulk of them.

In his letter, Mr. Crist outlined his state's efforts to support the rescue effort, helping both the healthy and the sick streaming into the state. "Florida's health care system is quickly reaching saturation," he wrote.

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