麻豆女优

When Darius Settles died from COVID-19 on the Fourth of July, his family and the city of Nashville, Tennessee, were shocked. Even the mayor noted the passing of a 30-year-old without any underlying conditions 鈥� one of the city鈥檚 youngest fatalities at that point.

Settles was also uninsured and had just been sent home from an emergency room for the second time, and he was worried about medical bills. An investigation into his death found that, like many uninsured COVID-19 patients, he had never been told that cost shouldn鈥檛 be a concern.

Back at the end of June, Settles and his wife, Angela, were both feeling ill with fevers and body aches. Then Darius took a turn 鈥� bad enough that he asked his wife to call an ambulance.

鈥淢y husband is having issues breathing and he鈥檚 weak, so we鈥檙e probably going to need a paramedic over here to rush him to the hospital,鈥� she told the operator, according to the 911 recordings obtained by WPLN News.

Darius Settles was stabilized and tested for the coronavirus at the hospital, according to his medical records. The doctor sent him home with antibiotics and instructions to come back if things got worse.

Three days later, they did. And now he also knew he had COVID-19; his test results were in.

But Settles was between full-time jobs, playing the organ at a church as he launched a career as a suit designer. So he had no health insurance.

His wife, who works for Tennessee State University, said he was worried about costs as he went back to the hospital a second time; she tried to reassure him

鈥淗e said, 鈥業 bet this hospital bill is going to be high.鈥� And I said, 鈥楤abe, it鈥檚 going to be OK.鈥� And we left it alone, just like that,鈥� she said.

When he returned to TriStar Southern Hills Medical Center, owned by the for-profit hospital chain HCA, physicians tested his blood oxygen levels, which are usually a first sign that a COVID-19 patient is in trouble. They had dropped to 88%. An X-ray of his lungs 鈥渁ppears worse,鈥� the physician wrote in the record.

But the doctor also noted that after a few hours in the emergency room his oxygen saturations had improved and he was breathing on room air. The records show they discussed why he might not want to be admitted to the hospital since he was otherwise young and healthy and didn鈥檛 note any risk factors for complications.

And when Angela Settles called to check in, he seemed to be OK with leaving despite his persistent struggle to breathe.

He was a COVID-19 patient so, 鈥淚 could not go up there to see him,鈥� she said. 鈥淗e was saying that I might as well go home.鈥�

Angela Settles was surprised since her husband was the one who wanted to go to the hospital in the first place.

At first, she thought the hospital just didn鈥檛 want to admit a man without insurance who would have trouble paying a big bill. But TriStar Southern Hills admits hundreds of patients a year without insurance 鈥� more than 500 in 2019, according to a spokesperson.

And in this case, the federal government would have paid the bill. But no one said that when it might have made a difference to Darius Settles.

The Message Never Makes It to Patients

TriStar, like most major health systems, participates in a program through the Centers for Medicare & Medicaid Services in which . It was set up through the pandemic relief legislation known as the CARES Act.

But TriStar doesn鈥檛 tell its patients that upfront. Neither do other hospitals or national health systems contacted by WPLN News. There鈥檚 no requirement to, which is聽, said of 麻豆女优, who studies uninsured patients. (KHN is an editorially independent program of 麻豆女优.)

鈥淭his is obviously a great concern to most uninsured patients,鈥� Tolbert said. Her 聽people without insurance often avoid care because of the bill or the threat of the bill, even though they might qualify for any number of programs if they asked enough questions.

Tolbert said the problem with the COVID-19 uninsured program is that even doctors don鈥檛 always know how it works or that the program exists.

鈥淎t the point when the patient shows up at the hospital or at another provider site, it鈥檚 at that point when those questions need to be answered,鈥� she said. 鈥淎nd it鈥檚 not always clear that that is happening.鈥�

Among clinicians, there鈥檚 a reluctance to raise the issue of cost in any way and run afoul of federal laws. Emergency rooms must at least stabilize everyone, regardless of their ability to pay, under聽. Asking questions about insurance coverage is often referred to as a 鈥渨allet biopsy,鈥� and can result in fines for hospitals or even being temporarily banned from receiving Medicare payments.

Physicians also don鈥檛 want to make a guarantee, knowing a patient still could end up having to fight a bill.

鈥淚 don鈥檛 want to absolutely promise anything,鈥� said Dr. , an ER physician in Lexington, Kentucky, and a board member of the American College of Emergency Physicians.

鈥淭here should not be a false sense that it will be an absolute smooth path when we鈥檙e dealing with government services and complexities of the health care system,鈥� he said.

鈥楥ould I Have Done More?鈥�

Darius Settles knew he was in bad shape. But he didn鈥檛 attempt to make a third trip to the hospital. Instead of 911, he called his father, pastor David Settles, and asked his father to come pray for him.

When the elder Settles replied that he was always praying for his son, Darius said, 鈥淣o, I really need you to pray for me. I need you to get the oil, lay hands on me and pray,鈥� David Settles recalls, and so he went, despite concerns about getting COVID-19 himself.

He sat by his son鈥檚 side. Darius鈥� wife made some peppermint tea, and when they put it to his lips, Darius didn鈥檛 sip. They thought he had fallen asleep. But he was unconscious.

At that point, they called 911 again and the operator instructed them to get Darius to the floor and perform chest compressions until paramedics arrived.

For 11 minutes, Angela Settles pumped her husband鈥檚 chest, occasionally asking the dispatcher 鈥渨hat鈥檚 taking so long,鈥� the 911 recordings show. Even after help showed up, Darius never revived.

Pastor Settles was聽just a few weeks later, preaching on suffering and grief after the death of his son, 鈥渨hom I watched as the breath left his body,鈥� he told his congregation. 鈥淭he Lord gives, and the Lord takes away.鈥�

Darius Settles left behind his own son, who was 6. And his widow鈥檚 head is still spinning. She said she can鈥檛 shake a sense of personal guilt.

鈥淐ould I have done more?鈥� Angela Settles asked. 鈥淭hat鈥檚 hard, and I know that he would not want me to feel like that.鈥�

She wondered, too, if the hospital could have done more for him. And even after failing to disclose its policy for uninsured COVID-19 patients, it did send her a bill for part of her husband鈥檚 care. Asked why, a TriStar spokesperson said it was sent in error and does not have to be paid.

This story is from a reporting partnership that includes聽,听听补苍诲听.