番茄社区

For the main story on the increasing number and severity of border wall-fall injuries that are overwhelming California trauma centers, click here.

When UC San Diego trauma surgeons realized that patients injured after falling off the wall along the California-Mexico border were not just soaring in number, but in severity, complexity, length of stay, and cost over the last 6 years, they decided to sound the alarm by doing what academics do.

They sought to publish their data in a reputable journal as quickly as they could.

The message they wanted to convey to anyone who would listen was that case counts from their trauma registry were increasing at the same time as the heights of the walls in California were raised under the Trump administration starting in 2019, said Jay Doucet, MD, chief of UC San Diego (UCSD) trauma services.

The UCSD team decided to take the quickest route to publication, submitting a brief to JAMA Surgery, whose editor, Doucet said, is known to have a special interest in disparities of care and social determinants of health and was likely to fast track the paper. A more extensive submission as an "original investigation" would take much longer and require a more complicated peer review process.

The group gathered their data in December, submitted it in March, and saw it published April 29. It showed a dramatic increase in severity and number of border wall fall trauma cases at UCSD, 375 in the three years from 2019 to 2021 compared with just 67 between 2016 to 2018.

But ever since then, "it's been hard to get journals interested in this topic," Doucet said.

Problematic Push to Publish

Brain injuries suffered by these patients have been particularly alarming.

"Our neurosurgeons were shocked by the number of head injuries they're seeing, and they have a paper they've been trying to submit, but it was rejected from a couple of well known journals," Doucet said. Editors gave no reason.

"Maybe they feel it's a political issue. But for us, it's not a political issue. It's reality -- a burden on our healthcare system. Regardless of your feelings of the wall, this isn't right and it isn't what was supposed to happen when the wall was built. There's a lot of suffering and death going on here that doesn't make a lot of sense, and that wasn't the policy objective of any administration."

Doucet said his team tried to collaborate with Scripps Mercy Hospital, which shares trauma calls every other month along the San Diego border, so the paper would include Scripps' wall fall morbidity statistics as well. "But it was taking them time to get their data together. They [Scripps Mercy] wanted to go through the traditional route of first writing an abstract, have it presented at a meeting, and then publishing the paper. And that was going to take a year, and as it turned out, that was rejected anyway."

More recently, Scripps Mercy, UCSD, and Rady Children's Hospital in San Diego collaborated on a short that calls the human toll from higher wall height "a public health crisis." In addition to showing a 967% increase in admissions for falls from the border wall along the California border between 2016 and 2021, the abstract documents median hospital per-patient charges growing from $68,663 per patient to $177,251, with 76% of the patients under-insured when they are admitted.

They submitted it to the largest trauma meeting, which publishes a major trauma journal, but Doucet said it was rejected. It was recently accepted for presentation at the Eastern Association for the Surgery of Trauma meeting in January but has not yet been peer-reviewed.

"Legislators and healthcare providers must conduct collaborative, apolitical discussions regarding the border wall's efficacy as a means of deterrence and its impact on traumatic injury and disability," the authors wrote.

One exception to the publication silence, Doucet said, was a four-paragraph presented in April at the Southwest Surgical Congress by a hospital in McAllen, Texas. It compared severity of injuries and lengths of stay for patients who fell from the border fence with those who fell from a similar height in domestic settings. Notably, it counted 61 falls from the border fence treated in hospitals between April 2014 and November 2019, but did not expand on increases in later years.

Impact on Hospitals

Chris Van Gorder, Scripps Health CEO, told 番茄社区 that so many media reports have made this a story more about immigration and politics when it's about patient care and tragedy. "The issue is people are dying and getting seriously injured" after falling from the border wall.

"A large part of our concern is the burden these incidents place on our on-call specialists -- especially ortho/neuro," he said.

Additionally, most of these patients have no source of insurance that rehabilitation facilities will accept, so patients have much longer lengths of stay in the hospital, he added. "That inability to move the patients creates capacity issues for hospitals and trauma centers."

There's a significant economic impact on hospitals when no source of reimbursement for wall fall patients' care can be billed, "but sadly, few care about that," Van Gorder said, "including our elected leaders."

Doucet and others noted that U.S. Customs and Border Patrol funds are supposed to pay a negotiated rate for these patients' hospital bills while the patients are in its custody after they've been apprehended. For a long time, the agency discharged these patients from their custody prior to their release from the hospital, and thus avoided having to pick up any of the tab.

California's Medicaid program has in recent years paid the bill for all individuals who have "unsatisfactory immigration status," except individuals ages 26-49, according to the state Department of Health Care Services. For that group of adults, Medi-Cal this year began covering care for undocumented patients in need of emergency and pregnancy-related care, but full scope coverage will not begin until January 2024.

While that's something, it's not enough, Doucet said, because Medi-Cal typically pays only 35 cents on a dollar's cost of care.

He added that UCSD officials have reached out to federal agencies, including the Department of Homeland Security, to discuss ways to reduce these tragic traumatic events.

"They listened to us, and provided some data on the wall, but we have not heard about any changes in paying for additional cases," he said.

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