Otros conductores se detuvieron, rompieron la ventana del auto y lo llevaron a un lugar seguro. Un bombero voluntario que pasaba por allí le practicó reanimación cardiopulmonar hasta que llegó una ambulancia que trasladó a Masterson al hospital UPMC Mercy.

Pasó 18 días en la unidad de cuidados intensivos (UCI), 14 de ellos conectado a un ventilador. Desarrolló delirio, una condición común en terapia intensiva, y necesitó medicamentos antisicóticos. A pesar de tener una sonda de alimentación, perdió peso. “Sinceramente, no estábamos seguros de que fuera a sobrevivir”, dijo Ron Dedes, su cuñado.

Pero sobrevivió. Masterson fue dado de alta el 1 de febrero y regresó a casa con apoyo familiar casi constante. Trabajando con varios tipos de terapeutas, ha recuperado la capacidad de caminar, aunque aún tiene debilidad, y puede ocuparse de su cuidado personal. Su habla, que antes era confusa, ha mejorado notablemente. Puede prepararse un sándwich.

Ahora, “nuestra mayor preocupación es su memoria”, dijo Dedes. Masterson, quien hasta hace poco manejaba asuntos legales complejos, olvida conversaciones y eventos que ocurrieron unas horas antes, explicó Patti Dedes, su hermana. Aún no puede usar un microondas ni hacer una llamada telefónica.

En una entrevista, se describió a sí mismo, con precisión, como “mucho, mucho mejor de lo que estaba”, pero se equivocó al decir su edad. Las pruebas de evaluación tras el alta indicaron deterioro cognitivo y depresión.

Entre los médicos de cuidados críticos, los síntomas prolongados como los suyos se conocen como “síndrome post-cuidados intensivos” o PICS (por sus siglas en inglés). Las secuelas pueden ser físicas o psicológicas, además de cognitivas, y pueden durar meses o años.

son admitidas cada año en terapias intensivas en unos 5.000 hospitales en Estados Unidos, y las investigaciones muestran que secundarios. La edad avanzada aumenta las probabilidades.

Los pacientes y sus familias suelen sorprenderse por estas dificultades persistentes. “La creencia es que saldrán del hospital y en dos o tres semanas volverán a la normalidad”, dijo Brad Butcher, quien fue el doctor de Masterson y en la revista médica JAMA. “Eso no se corresponde con la realidad”.

De hecho, con un mayor uso de las UCI y mejores tratamientos, la población que puede enfrentar este síndrome está creciendo. La Sociedad de Medicina de Cuidados Críticos (Society of Critical Care Medicine, SCCM) estima que a la terapia intensiva.

“Todos están agradecidos de que el paciente haya sobrevivido”, dijo Lauren Ferrante, doctora en cuidados críticos pulmonares e investigadora en la Facultad de Medicina de Yale (Yale School of Medicine). “Pero ese es solo el comienzo de un largo camino de recuperación”. En un estudio de pacientes de 70 años o más, del que fue coautora, dentro de los seis meses posteriores al alta solo alrededor de la mitad .

Los pacientes de cuidados intensivos enfrentan . Los síntomas del PICS van —debilidad, dolor, neuropatía (hormigueo en brazos y piernas) y desnutrición— , principalmente ansiedad y depresión. Las como las de Masterson son comunes, incluidos problemas de memoria, atención y concentración, y lenguaje.

“Para muchas personas, sobrevivir a una enfermedad crítica es una experiencia que cambia la vida”, afirmó Butcher. Los pacientes en cuidados intensivos después de cirugías de emergencia o programadas también presentan físicos, mentales y cognitivos un año después.

Los mismos tratamientos intensivos que salvan vidas contribuyen al síndrome. Los pacientes en cuidados intensivos “tienen algún tipo de falla grave de órganos que requiere atención inmediata” y monitoreo constante, explicó Carla Sevin, doctora en cuidados críticos pulmonares que dirige el Centro de Recuperación de UCI en el Centro Médico de la Universidad de Vanderbilt.

Eso puede implicar un tubo de respiración conectado a un ventilador, lo que a su vez suele requerir medicamentos sedantes. La sedación “puede provocar delirio, y el delirio es el factor clave en los síntomas cognitivos”, dijo Butcher.

Tampoco ayuda que los pitidos constantes de los monitores y la iluminación brillante las 24 horas interrumpan el sueño, ni que las restricciones en las visitas familiares priven a los pacientes de rostros y voces tranquilizadoras.

Gregory Matthews, un contador jubilado en St. Petersburg, Florida, pasó casi un mes en una UCI tras un trasplante de pulmón en 2014. Aún recuerda con claridad sus alucinaciones, incluidas imágenes de ratones corriendo por la pared y alguien intentando incriminarlo por tráfico de drogas.

“Un día, pensé que un doctor era un asesino; podía ver el rifle”, dijo Matthews, ahora de 80 años. “Así que salté de la cama”, contó, y se arrancó las vías intravenosas. El personal tuvo que sujetarle los brazos durante varios días.

Pero la inmovilización también tiene consecuencias, ya que los pacientes pierden rápidamente masa muscular y fuerza. “Nuestros cuerpos no están hechos para estar acostados todo el día”, señaló Ferrante.

En el plano psicológico, “el trastorno de estrés postraumático es bastante común, similar al que se observa en veteranos de combate o sobrevivientes de agresión sexual”, dijo Sevin. Las familias también pueden sufrir ansiedad y depresión junto con los pacientes.

Alarmados por estos hallazgos, médicos y administradores de unos 35 hospitales en Estados Unidos han establecido , donde equipos de doctores, enfermeros, farmacéuticos, terapeutas (físicos, ocupacionales, cognitivos, del habla) y trabajadores sociales evalúan múltiples condiciones y ayudan a los pacientes a enfrentarlas.

La clínica de Vanderbilt atendió a su primer paciente en 2012. El Centro de Recuperación de Enfermedades Críticas del Centro Médico de la Universidad de Pittsburgh —fundado por Butcher en 2018— trabaja con unos 100 pacientes al año, incluido Masterson. Yale abrió su clínica en 2022.

Estas clínicas aplican seis prácticas recomendadas por la Sociedad de Medicina de Cuidados Críticos que han demostrado reducir de forma significativa los . Las medidas incluyen usar sedación más ligera, hacer que los pacientes se levanten y se muevan antes, evaluar su respiración diariamente para retirar el ventilador más pronto y eliminar restricciones en las visitas familiares.

Las clínicas suelen ofrecer grupos de apoyo para pacientes y familias. Hay evidencia de que llevar un diario de la UCI, en el que pacientes y cuidadores registran sus experiencias, y participar en ejercicio y rehabilitación física después del alta.

También se abordan conversaciones sobre qué otras opciones preferirían los pacientes si enfrentan otra enfermedad crítica, como ocurre con muchos. ¿Aceptarían nuevamente cuidados intensivos y el riesgo de sus secuelas? ¿O elegirían cuidados paliativos, que priorizan la comodidad en lugar de la curación? Algunos pacientes quedan con discapacidades permanentes después de la UCI.

Butcher, aunque señaló que estas nuevas prácticas deben ampliarse mucho más, se mostró optimista sobre el futuro de los cuidados críticos. “Vamos a encontrar mejores herramientas de diagnóstico, mejores estrategias de prevención y mejores tratamientos”, dijo.

Por ahora, sin embargo, la experiencia en la UCI sigue siendo desorientadora y a veces traumática. Cuando Butcher preguntó a 117 pacientes en su clínica post-UCI sobre qué harían en el futuro, muchos querían poner límites a las intervenciones médicas.

Alrededor de un tercio preferiría reducir el nivel de atención agresiva. De ellos, cerca de una cuarta parte optaría por órdenes de “no resucitar” y “no intubar”, y casi el 7% dijo que no querría volver nunca a una UCI.

Masterson sigue trabajando en su recuperación. “No he salido mucho”, dijo. “He estado más bien en casa”. Espera recuperar la fuerza suficiente para volver a correr; antes solía correr entre 3 y 4 millas varias veces por semana.

El futuro de los pacientes con síndrome post-UCI suele depender de su estado físico, mental y cognitivo antes de la hospitalización. La buena condición física previa de Masterson y su trabajo exigente a nivel cognitivo son factores positivos para su recuperación, señaló Butcher.

Su familia oscila entre la esperanza y la preocupación. “Quién sabe cómo estará más adelante”, dijo Dede, su cuñado. “Vamos día a día”.

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Other drivers stopped, broke the car window, and pulled him to safety. A passing volunteer firefighter performed CPR until an ambulance arrived to take Masterson to UPMC Mercy hospital.

He spent 18 days in the medical intensive care unit there, 14 of them on a ventilator. He developed delirium, a common ICU condition, and needed antipsychotic drugs. Despite a feeding tube, he lost weight. “We honestly weren’t confident that he would pull through,” said Ron Dedes, his brother-in-law.

But he did. Masterson was discharged Feb. 1 and returned home with near-constant family support. Working diligently with several kinds of therapists, he has regained his ability to walk, despite lingering weakness, and to manage his personal care. His once-garbled speech has markedly improved. He can make himself a sandwich.

Now, “our biggest concern is his memory,” Dedes said. Masterson, who so recently handled complex legal matters, forgets conversations and events that happened a few hours earlier, said Patti Dedes, his sister. He can’t yet operate a microwave or place a phone call.

In an interview, he described himself, accurately, as “much, much better than I was” — but misstated his age. Screening tests after his discharge indicated cognitive impairment and depression.

Among critical-care doctors, prolonged symptoms like his are known as “post-intensive care syndrome,” or PICS. The fallout can be physical or psychological, as well as cognitive, and can persist for months or years.

More than are admitted to intensive care across about 5,000 American hospitals, and research shows that . Older age increases the odds.

Patients and families are often startled by these continuing difficulties. “The belief is that they’ll be discharged from the hospital and in two or three weeks, they’ll be back to normal,” said Brad Butcher, who was Masterson’s doctor and in the medical journal JAMA. “That doesn’t comport with reality.”

In fact, with greater ICU use and improved treatments — the Society of Critical Care Medicine estimates that their stays — the population likely to encounter the syndrome is growing.

“Everyone is grateful that the patient has survived,” said Lauren Ferrante, a pulmonary critical-care doctor and researcher at the Yale School of Medicine. “But that’s just the start of a long road to recovery.” In a study of patients 70 and older that she co-authored, within six months after discharge only about half had .

Intensive care patients face a . PICS symptoms — weakness, pain, neuropathy (tingling in arms and legs), and malnutrition — to , primarily anxiety and depression. like Masterson’s are commonplace, including problems with memory, attention and concentration, and language.

“For many people, surviving a critical illness is a life-altering experience,” Butcher said. Patients in intensive care after emergency or elective surgery also of new physical, mental, and cognitive problems a year later.

The same aggressive treatments that save lives contribute to the syndrome. Intensive care patients “have some sort of dramatic organ failure that requires immediate attention” and constant monitoring, explained Carla Sevin, a pulmonary critical-care doctor who directs the ICU Recovery Center at Vanderbilt University Medical Center.

That could mean a breathing tube attached to a ventilator, which in turn often requires sedating drugs. Sedation “can precipitate delirium, and delirium is the key factor in cognitive symptoms,” Butcher said.

It doesn’t help that constant beeps and alarms from monitors and round-the-clock bright lighting disrupt sleep, and that restrictive family visiting hours deprive patients of reassuring faces and voices.

Gregory Matthews, a retired accountant in St. Petersburg, Florida, spent nearly a month in an ICU after a lung transplant in 2014. He still vividly remembers his hallucinations, including mice running across the wall and someone trying to frame him for drug running.

“One day, I thought a doctor was an assassin — I could see the rifle,” said Matthews, now 80. “So I jumped out of bed,” he said, and yanked out his IVs. The staff put his arms in restraints for days.

But immobilization exacts its own toll as patients quickly lose muscle mass and strength. “Our bodies were not meant to lie in bed all day,” Ferrante said.

Psychologically, “PTSD is pretty common, similar to what’s seen in combat veterans or sexual assault survivors,” Sevin said, referring to post-traumatic stress disorder. Families can suffer anxiety and depression along with the patients.

Alarmed by such discoveries, doctors and administrators at about 35 U.S. hospitals have established , where teams of doctors, nurses, pharmacists, therapists (physical, occupational, cognitive, speech), and social workers screen for a host of conditions and help guide patients through them.

Vanderbilt’s clinic saw its first patient in 2012. The Critical Illness Recovery Center at the University of Pittsburgh Medical Center, which Butcher founded in 2018, works with about 100 patients a year, including Masterson. Yale opened its clinic in 2022.

They rely on six practices recommended by the Society of Critical Care Medicine that are shown to . The measures call for changes such as using lighter sedation, getting patients up and moving earlier, testing their breathing daily to wean them from ventilators sooner, and removing restrictions on family visiting.

Clinics often offer support groups for patients and families. There’s evidence that keeping an ICU diary, in which patients and caregivers record their experiences, and engaging in exercise and physical rehabilitation after discharge.

Also on the clinics’ agenda: discussions of what other options patients might prefer if they face another critical illness, as many do. Would they agree to undergo intensive care and risk its aftereffects again? Or choose palliative care, which emphasizes comfort rather than cure? Some post-ICU patients remain permanently impaired.

Butcher, although he said that the use of the new practices needed to expand dramatically, sounded optimistic about the future of critical care. “We’re going to find better diagnostic tools, better preventive strategies, and better therapies,” he said.

For now, though, the ICU experience remains disorienting and sometimes traumatic. When Butcher asked 117 patients in his post-ICU clinic those next-time questions, many wanted to place limits on further medical interventions.

About a third would want to lower the level of aggressive care. Of those, about a quarter would want “do not resuscitate” and “do not intubate” orders, and almost 7% said they never wanted to return to an ICU.

Masterson is working hard to further his recovery. “I haven’t been out and about much,” he said. “I’ve been kind of homebound.” He hopes to get strong enough to resume running — he used to log 3 to 4 miles several times a week.

The future for patients contending with post-ICU syndrome often depends on their physical, mental, and cognitive health before their admission. Masterson’s previous fitness and cognitively demanding work bode well for his further progress, Butcher said.

His family remains alternatively hopeful and worried. “Down the road, what’s it going to be like?” Dedes, his brother-in-law, wondered. “We just take it day by day.”

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En pocos días, Reynolds estaba tan desesperada que ella y su esposo tuvieron que sujetar físicamente a Jonah para obligarlo a tomar el remedio, echándoselo en la garganta mientras él gritaba de dolor.

“Nos rompió el corazón”, contó Reynolds, que en ese momento vivía en Georgetown, Kentucky. “Y recuerdo que pensé que no debería tener que llegar a eso”.

Reynolds no pudo encontrar un dentista con una cita disponible que pudiera atender a Jonah, que es autista y a menudo se resiste a los exámenes dentales por hipersensibilidad y ansiedad. Durante cinco días, Reynolds llevó a Jonah dos veces a una sala de emergencias cercana, mientras el niño lidiaba con un dolor persistente y fiebre por lo que probablemente fuera un diente infectado con un nervio expuesto.

En la sala de emergencias no había dentistas; las dos veces la familia regresó a casa solo con analgésicos y una bolsa de hielo.

En todo el país, cada vez más niños llegan a las salas de emergencias por problemas dentales prevenibles. Dentistas, higienistas e investigadores atribuyen esa tendencia a la falta de profesionales de odontología pediátrica en zonas rurales y a un deterioro de la higiene bucal desde la pandemia de covid-19.

Decenas de miles de niños terminan en el hospital por emergencias dentales cada año, según Melissa Burroughs, directora sénior de políticas y defensa del paciente de la organización nacional sin fines de lucro CareQuest Institute for Oral Health.

Las visitas a salas de emergencias por problemas dentales no relacionados con lesiones físicas aumentaron en niños menores de 15 años entre 2019 y 2022, según un informe publicado a finales del año pasado por CareQuest.

Los datos locales reflejan esa tendencia nacional.

En el Hospital de Niños de Colorado, en el área de Denver, los casos dentales no traumáticos —como caries o infecciones de encías— atendidos en la sala de emergencias aumentaron un 175% entre 2010 y 2025, según Sarah Bonar, vocera del hospital.

En Kentucky, donde vive Jonah, las visitas de niños a salas de emergencia por problemas dentales aumentaron un 72 % entre 2020 y 2024, según los registros del estado.

Los cambios de política ejecutados por el gobierno de Donald Trump podrían empeorar la tendencia.

La ley de reconciliación presupuestaria federal de 2025 impulsada por el presidente, conocida como One Big Beautiful Bill Act, pidió recortes de miles de millones de dólares a Medicaid, lo que podría obligar a los estados a limitar o eliminar la cobertura dental del programa de salud pública para personas con bajos ingresos o con discapacidades.

Nuevos requisitos de elegibilidad de Medicaid en algunos estados podrían afectar el acceso de los niños a la atención dental, aunque el programa les garantiza esa cobertura. Investigaciones muestran que cuando los padres pierden Medicaid, incluso los niños que mantienen su cobertura tienen más probabilidades de tener y de ir al dentista.

La administración Trump también ha promovido el escepticismo sobre el flúor. muestran que el flúor en el agua potable y los tratamientos tópicos con flúor previenen y reducen de forma importante la caries dental.

En meses recientes, la Administración de Alimentos y Medicamentos (FDA, por sus siglas en inglés) contra el uso de suplementos de flúor y la Agencia de Protección Ambiental (EPA, por sus siglas en inglés) sobre “posibles riesgos para la salud del flúor en el agua potable”.

El secretario de Salud y Servicios Humanos, Robert F. Kennedy Jr., ha llamado al flúor un “” y un “”. Un estudio de 2025 en JAMA Pediatrics vinculó niveles altos de flúor con un coeficiente intelectual más bajo en niños, pero solo con concentraciones del nivel recomendado en el agua potable pública.

, un dentista pediátrico en la University of Washington que estudia la reticencia al flúor, teme que las posturas anti flúor erosionen aún más la confianza en los tratamientos con flúor.

Desde el comienzo de 2026, legisladores en por lo menos 15 estados han presentado proyectos de ley para prohibir o limitar el flúor en el agua potable pública. Utah y Florida se convirtieron en 2025 en los primeros estados en aprobar esas prohibiciones.

“¿Eso va a tener un efecto en las tasas de caries? Absolutamente”, sostuvo Chi.

Aumentan los casos dentales graves

Las dentistas pediátricas Katherine Chin y Chaitanya Puranik dijeron que están atendiendo a más pacientes como Jonah en el hospital infantil de Colorado. Los casos graves también se han vuelto más frecuentes. Puranik agregó que antes, por lo general, veía pacientes con una sola caries, pero ahora a menudo llegan con caries en toda la boca.

Durante la pandemia, muchos consultorios dentales . Además, estudios muestran que los niños también , un factor de riesgo importante para los problemas dentales.

Las caries graves que llevan a la extracción de dientes pueden afectar el y, a veces, causar problemas a largo plazo para o .

Millones de personas viven en zonas de Estados Unidos donde , con pocos dentistas a una distancia razonable en auto. Además, según la American Dental Association, solo atiende a pacientes de Medicaid, debido a las bajas tasas de reembolso, que en promedio son de lo que cobran habitualmente.

Los niños con discapacidades intelectuales o del desarrollo pueden tener aun más dificultades para acceder a atención dental de calidad.

Pocos dentistas generales tienen suficiente formación pediátrica para atender a niños con discapacidades como Jonah, que se agobian con facilidad o necesitan sedación para un examen, una organización sin fines de lucro de información de salud que incluye a ���ϳԹ��� News.

tienen necesidades especiales de atención médica, y esos niños tienen de no tener cubiertas sus necesidades dentales. Sus padres también de tener problemas para .

Cuando era más pequeño, Jonah no dejaba que sus papás le cepillaran los dientes. Esto le generó caries en sus dientes de leche, explicó su mamá.

Después de la primera visita de Jonah a la sala de emergencias, Reynolds encontró un dentista general que tenía una cita disponible. Pero, a diferencia de un dentista pediátrico capacitado, dijo, el dentista no supo cómo examinar a Jonah de una forma que él pudiera tolerar y no estaba preparado para sedarlo. Jonah se fue sin tratamiento y pronto, cuando volvió la fiebre, regresó a la sala de emergencias.

Las salas de emergencias rara vez ofrecen soluciones

, pediatra en el condado de Washington, en Maine, aseguró que está viendo “las caries más horribles” en Down East Community Hospital.

Las salas de emergencia a menudo no están preparadas para tratar problemas dentales, explicó Weitz. Como a la que fue Jonah en Kentucky, Down East no tiene dentistas entre su personal. Weitz a menudo termina recetando antibióticos como medida temporal. “Pero un mes después, los pacientes regresan porque la situación vuelve a agravarse”, dijo Weitz.

Como posible solución, estados como Maine y Alaska están proponiendo usar fondos del , dotado con $50.000 millones, para desarrollar la fuerza laboral de salud bucal o crear centros especializados de atención dental que puedan atender mejor y más rápido a niños con necesidades especiales de atención médica.

Pero esas iniciativas no resolverán la pérdida de cobertura que se anticipa por ��los recortes a Medicaid.

El año pasado, California otorgó $47 millones en subvenciones estatales para desarrollar o ampliar más de 120 centros odontológicos destinados a atender a pacientes con necesidades especiales de atención médica.

La emergencia dental de Jonah le costó a Reynolds una semana sin trabajar en su empleo como peluquera de perros y a Jonah tres días de tercer grado, además de los cientos de dólares que tuvieron que pagar de su propio bolsillo.

Finalmente, Reynolds encontró a un especialista en cirugía oral que le extrajo el diente. Pero incluso eso salió mal. Cuando Jonah se alteró por el pinchazo de una aguja, el cirujano amenazó con sujetarlo por la fuerza, contó Reynolds. Agregó que el profesional se fue rápidamente después del procedimiento sin darle un diagnóstico claro de qué había causado el dolor de Jonah.

La extracción terminó con el dolor de muelas, pero Reynolds opinó que más profesionales deberían saber cómo manejar casos como el de Jonah, con más sensibilidad hacia las familias.

Cuatro años después, todavía sigue fresco en su memoria el momento en que tuvo que obligar a Jonah a tomar el medicamento para el dolor. “Eso nunca se me va a olvidar”, concluyó Reynolds.

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Within a few days, Reynolds became so desperate that she and her husband had to physically restrain Jonah, dumping pain medication down his throat as he screamed in pain.

“It broke our hearts,” said Reynolds, who lived in Georgetown, Kentucky, at the time. “And I remember just thinking that it shouldn’t have to come to that.”

Reynolds couldn’t find a dentist with an opening who could treat Jonah, who is autistic and often resists dental exams due to hypersensitivity and anxiety. Over the course of five days, Reynolds took Jonah twice to a nearby emergency room as he struggled with persistent pain and a fever due to a likely infected tooth with an exposed nerve. The ER had no dentists; both times, the family was sent home with only pain medication and an ice pack.

Across the nation, more children are entering ERs for preventable tooth problems. Dentists, hygienists, and researchers attributed that trend to a shortage of pediatric dental care professionals in rural areas and worsening oral hygiene since the covid-19 pandemic. Tens of thousands of kids end up in the hospital for dental emergencies each year, according to Melissa Burroughs, senior director of policy and advocacy at the national health nonprofit CareQuest Institute for Oral Health.

ER visits for tooth problems unrelated to physical injuries for children under 15 years old from 2019 to 2022, according to a report released late last year by CareQuest. And local data reflects that national trend: At Children’s Hospital Colorado in the Denver area, nontraumatic dental cases, such as cavities or gum infections, in its ER increased 175% from 2010 to 2025, according to hospital spokesperson Sarah Bonar. In Kentucky, where Jonah lives, children’s visits to the ER for dental problems rose 72% from 2020 to 2024, according to the state.

Policy changes under the Trump administration are poised to worsen the trend. President Donald Trump’s 2025 federal budget reconciliation law, known as the One Big Beautiful Bill Act, called for billions in cuts from Medicaid, which may force states to limit or drop dental coverage from the public insurance program for those with low incomes or disabilities. New eligibility requirements for Medicaid in some states could affect kids’ access to dental care, even though children are guaranteed dental coverage under the program. Research shows that when parents lose Medicaid, even kids with coverage are more likely to have and to go to a dentist.

The Trump administration has also promoted skepticism about fluoride. show that fluoride in drinking water and topical fluoride treatments dramatically reduce tooth decay and prevent cavities. In recent months, the Food and Drug Administration against the use of fluoride supplements and the Environmental Protection Agency of “potential health risks of fluoride in drinking water.” Health and Human Services Secretary Robert F. Kennedy Jr. has called fluoride a “” and “.” A 2025 study in JAMA Pediatrics linked high levels of fluoride with lower IQ in children — but only at concentrations the recommended level in public drinking water.

, a pediatric dentist at the University of Washington who studies fluoride hesitancy, worries that these anti-fluoride stances will further erode trust in fluoride treatment. Since the start of 2026, lawmakers in at least 15 states have introduced bills prohibiting or limiting fluoride in public drinking water. Utah and Florida in 2025 became the first states to enact fluoride bans.

“Will that have an effect on cavity rates?” Chi asked. “Absolutely.”

Severe Dental Cases Rise

Pediatric dentists Katherine Chin and Chaitanya Puranik said they are treating more patients like Jonah at Children’s Hospital Colorado. More severe cases have become more common, too. Puranik said he used to typically see patients with only one cavity, but now his patients are often coming in with tooth decay throughout their mouth.

During the pandemic, many dental offices , and studies show children also increased , a major risk factor for cavities. Severe cavities that lead to tooth extraction can affect , sometimes causing long-term problems with or .

Millions of people live in in the U.S., with scant dentists within driving distance. On top of that, only treat Medicaid patients, due to low reimbursement rates, which are on average of their typical dental charges, according to the American Dental Association.

Children with intellectual or developmental disabilities may especially struggle to access quality dental care. Few general dentists have sufficient pediatric training to care for kids with disabilities such as Jonah, who are easily overwhelmed or need to be sedated for an exam, , a health information nonprofit that includes ���ϳԹ��� News. Over have special health care needs, and those children are to have unmet dental needs. Their parents are also to finding a dentist.

When he was younger, Jonah would not let his parents brush his teeth, which led to cavities in his baby teeth, his mother said. After Jonah’s first visit to the ER, Reynolds found a general dentist with an opening. But unlike a trained pediatric dentist, she said, the dentist did not know how to examine Jonah in a way he could tolerate and wasn’t prepared to provide sedation. Jonah left without treatment and was soon back in the ER when his fever returned.

ERs Rarely Provide Solutions

, a pediatrician in Washington County, Maine, said he is fielding “the most horrifying cavities” at Down East Community Hospital.

ERs are often ill-equipped to treat dental concerns, Weitz said. Similar to the ER Jonah went to in Kentucky, Down East has no dentists on staff. Weitz often finds himself prescribing antibiotics as a temporary measure.

“But a month later, they’re back again because it’s flaring up again,” Weitz said.

As a potential solution, states such as Maine and Alaska are proposing to use money from the $50 billion to develop the oral health workforce or to create specialized dental care centers, which can better serve children with special health care needs on short notice. But those initiatives won’t address the loss of coverage anticipated from Medicaid cuts. California last year in state grants to develop or expand over 120 dental facilities to serve patients with special health care needs.

Jonah’s dental emergency cost Reynolds a week of work from her job as a dog groomer and Jonah three days of third grade, plus hundreds of dollars in out-of-pocket costs.

Eventually, Reynolds found an oral surgeon who extracted the tooth. But even that went poorly, she said. When Jonah became upset over a needle stick, the surgeon threatened to hold him down, Reynolds said. She said the surgeon left quickly after the procedure and never gave her a clear diagnosis of what caused Jonah’s pain. The procedure did resolve his toothache, but Reynolds said more professionals should know how to handle cases like Jonah’s, with sensitivity to the families. Four years later, forcing Jonah to take his pain meds still lives fresh in her memory.

“That will never leave my mind,” Reynolds said.

���ϳԹ��� 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 .

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Millions of Americans are facing dramatically higher health insurance premium payments due to the Jan. 1 expiration of enhanced Affordable Care Act subsidies. But much of Washington appears more interested at the moment in culture war issues, including abortion and gender-affirming care.

Meanwhile, at the Department of Health and Human Services, personnel continue to be fired and rehired, and grants terminated and reinstated, leaving everyone who touches the agency uncertain about what comes next.

This week’s panelists are Julie Rovner of ���ϳԹ��� News, Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• Congress remains undecided on a deal to renew enhanced ACA premium subsidies, as it is on spending plans to keep the federal government running when the existing, short-term plan expires at the end of the month. While some of the bigger appropriations hang-ups are related to immigration and foreign affairs, there are also hurdles to passing spending for HHS.
• ACA plan enrollment is down about 1.5 million compared with last year, with states reporting that many people are switching to cheaper plans or dropping coverage. Enrollment numbers are likely to drop further in the coming months as more-expensive premium payments come due and some realize they can no longer afford the plans they’re enrolled in.
• A key Senate health committee on Wednesday hosted a hearing on the abortion pill mifepristone, focused on the safety concerns posed by abortion foes — though those concerns are unsupported by scientific research and decades of experience with the drug. Many abortion opponents are frustrated that the Trump administration has not taken aggressive action to restrict access to the abortion pill.
• As the Trump administration moved this week to rehire laid-off employees and abruptly cancel, then restore, addiction-related grants, overall government spending is up, despite the administration’s stated goal of saving money by cutting the federal government’s size and activities. It turns out the churn within the administration is costing taxpayers more. And new data, revealing that more federal workers left on their own than were laid off last year, shows that a lot of institutional memory was also lost.

Also this week, Rovner interviews ���ϳԹ��� News’ Elisabeth Rosenthal, who created the “Bill of the Month” series and wrote the latest installment, about a scorpion pepper, an ER visit, and a ghost bill. If you have a baffling, infuriating, or exorbitant bill you’d like to share with us, you can do that here.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The New York Times’ “,” by Maxine Joselow.

Alice Miranda Ollstein: ProPublica’s “,” by Anna Clark.

Joanne Kenen: The New Yorker’s “,” by Dhruv Khullar.

Anna Edney: MedPage Today’s “,” by Joedy McCreary.

Also mentioned in this week’s podcast:

• The Washington Post’s “,” by Paul Kane.
• HealthAffairs’ “,” by Mica Hartman, Anne B. Martin, David Lassman, and Aaron Catlin.
• Politico’s “,” by Alice Miranda Ollstein.
• JAMA’s “,” by Sophie Dilek, Joanne Rosen, Anna Levashkevich, Joshua M. Sharfstein, and G. Caleb Alexander.

[Editor’s note:��This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]��

Julie Rovner:��Hello from ���ϳԹ��� News and WAMU��public��radio in Washington, D.C., and welcome to��What the Health?��I’m��Julie Rovner, chief Washington correspondent for ���ϳԹ��� News, and��I’m��joined by some of the best and smartest health reporters in Washington.��We’re��taping this week on Thursday, Jan. 15, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go.��

Today,��we are joined via video conference by Anna Edney��of��Bloomberg News.��

Anna Edney:��Hi, everyone.��

Rovner:��Alice [Miranda]��Ollstein��of Politico.��

Alice Miranda��Ollstein:��Hello.��

Rovner:��And��Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine.��

Joanne Kenen:��Hi, everybody.��

Rovner:��Later in this episode,��we’ll��have my interview with ���ϳԹ��� News’��Elisabeth Rosenthal, who reported and wrote the latest��“Bill of the Month,”��about an ER trip, a scorpion pepper, and a ghost bill. But first,��this week’s news.��Let’s��start this week on Capitol Hill, where both houses of Congress are here and legislating. This week alone, the Senate rejected a Democratic effort to accept the House-passed bill that would renew for three��years��the Affordable Care Act’s expanded subsidies��—��the ones that expired Jan. 1.����

The Senate also turned back an effort to cancel the Trump administration’s regulation covering the ACA, which, although it has gotten far less attention than the subsidies, would also result in a lot of people losing or dropping health insurance coverage.����

Meanwhile, in the House, Republicans are struggling just to keep the lights on. Between resignations, illnesses, and deaths, House Republicans are��very nearly��—��in the words of longtime Congress watcher����—��a��[majority]��in name only, which I guess is pronounced��“MINO.”��Their majority is now so thin that one or two votes can hand Democrats a win, as we saw earlier this week in a surprise defeat on an otherwise��fairly routine��labor bill.��Which brings us to the prospects for renewing those Affordable Care Act subsidies. When the dust cleared from last week’s House vote, 17 Republicans joined all the��House’s Democrats��to pass��the bill and send��it to the Senate.��But it seems that the bipartisan efforts in the Senate to get a deal are losing steam.��What’s the latest you guys are hearing?��

Ollstein:��Yeah, so it��wasn’t��a good sign when the person who has��sort of come��out as a leader of these bipartisan negotiations,��Ohio Sen.��Bernie��Moreno, at first came out��very strong��and said,��We’re��in the end zone.��We’re��very��close��to a deal.��We’re��going to have��bill��text.��And that was several days ago, and now��they’re��saying that��maybe��they’ll��have something by the end of the month. But the initial enthusiasm very quickly fizzled as they really got into the negotiations, and,��from what my colleagues have reported, there’s still disagreements on several fronts, you know, including this idea of having a minimum charge for all plans, no zero-premium plans anymore, which the right says is to crack down on fraud, and the left says would really deter low-income people from getting coverage. And there, of course, is, as always, a fight about abortion, as we spoke about on this podcast before.��There is��not��agreement on how Obamacare currently treats abortion, and thus there can be no agreement on how it��should��treat abortion.��

And��so��the two sides have not come to any kind of compromise. And I don’t know what compromise would be possible, because all of the anti-abortion activist groups and their allies in Congress, of which there are many, say that the only thing they’ll accept is a blanket national ban on any plan that covers abortion receiving a subsidy, and that’s a��nonstarter��for most, if not all, Democrats.��So��I��don’t��know where we��go��from here.��

Rovner:��Well, we will talk more about both abortion and the ACA in a minute, but first, lawmakers have just over two weeks to finish the remaining spending bills, or else risk yet another government shutdown. They��seem to��[be]��making some headway on many of those spending bills, but not so much on the bill that funds most of the Department of Health and Human Services. Any chance they can��come up with��a bill that can get 60 votes in the Senate and a majority in the much more conservative House?��That is a pretty narrow needle to thread.��I��don’t��think abortion is going to be a��huge issue in��Labor,��HHS,��because��that’s��where the Hyde Amendment lives, and we usually see the Hyde Amendment renewed. But, you know, I see a lot of Democrats and, frankly, Republicans in the Senate wanting to put money back for a lot of the things that HHS has cut, and the��House��[is]��probably not so excited about putting all of that money back.��I’m��just wondering if there really is a deal to be had, or if��we’re��going to see for the,��you know, however many��year[s]��in a row, another continuing resolution, at least for the Department of Health and Human Services.��

Ollstein:��Well,��you’re��hearing a lot more optimism from lawmakers about the spending bill than you are about a[n]��Obamacare subsidy deal or any of the other things that��they’re��fighting about. And I would say,��on the��spending,��I think the much bigger fights��are going to be outside the health care space. I think��they’re��going to be about immigration, with everything��we’re��seeing about foreign policy, whether and how to put restraints on the Trump administration, on both of those fronts.��On health,��yes, I think��you’ve��seen efforts to restore funding for programs that was slashed by the Trump administration, and you are seeing some Republican support for that. I mean, it��impacts��their districts and their voters too. So that makes sense.��

Kenen:��We’ve��also seen the Congress vote for spending that the administration��hasn’t��been spent.��So��Congress has just voted on a series of things about science funding and other��health-related��issues, including global health. But it remains to be seen whether this administration takes appropriations as law or��suggestion.��

Rovner:��So��while the effort to revive the��additional��ACA subsidies appears to be losing steam, there does seem to be some new hope for a bipartisan health package that almost became law at the end of 2024, so 13 months ago.��Back then, Elon Musk got it stripped from the year-end spending bill because the bill, or so Musk said, had gotten too big. That health package includes things like reforms for pharmacy benefits managers and hospital��outpatient payments,��and continued funding for community health centers. Could that finally become law? That thing that they said,��Oh,��we’ll��pass it first thing next year, meaning 2025.��

Edney:��I think��it’s��certainly looking more likely than the subsidies that��we’ve��been talking about. But I do think��we’ve��been here before several times, not just at the end of last year��—��but,��like with these PBM reforms, I feel like they have certainly gotten to a point where��it’s��like,��This��is happening.��It’s��gonna��happen.��And, I mean,��it’s��been years, though, that��we’ve��been talking about pharmacy benefit manager reforms in the space of drug pricing.��So basically, you��know, from��when��[President Donald]��Trump won. And so, you know, I say this with, like, a huge amount of caution:��Maybe.��

Rovner:��Yeah, we will, but��we’ll��believe it when��…��we get to the signing ceremony.��

Ollstein:��Exactly.��

Rovner:��Well, back to the Affordable Care Act, for which enrollment in most states��end��today.��We’re getting an early idea of how many people actually are dropping coverage because of the expiration of those subsidies.��Sign-ups on the federal marketplace are down about��1.5��million from the end of last year’s enrollment period, and��that’s��before most people��have to��pay their first bill. States that run their own marketplaces are also reporting that people are dropping coverage, or else trying to shift to cheaper plans.��I’m��wondering if these early numbers��—��which are��actually stronger��than many predicted, with fewer people��actually dropping��coverage��—��reflect people who signed up hoping that Congress might��actually renew��the subsidies this month. Since we kept saying that was��possible.��

Ollstein:��I would bet that most people are not following the��minutiae of��what’s��happening on Capitol Hill and have no��idea��the mess��we’re��in,��and��why,��and��who’s��responsible. I would love to be wrong about that. I would��love for��everyone to be super informed.��Hopefully��they��listen��to this podcast. But you know, I think that a lot of people just��sign up��year after year and��aren’t��sure of��what’s��going on until��they’re��hit with the giant bill.����

Rovner:��Yeah.��

Ollstein:��One thing I will point out about the emerging numbers is it does show,��at least early indications,��that the steps a lot of states are taking to make up for the shortfalls and put their own funding into helping people and subsidizing plans,��that’s really working.��You’re��seeing��enrollment up��in some of those states, and so I wonder if��that’ll��encourage any others to get on board as well.��

Kenen:��But��… I think what Julie said��is��it’s��…��the follow-up is less than expected. But for the reasons Julie just��said��is that you haven’t gotten your bill yet.��So��either you��haven’t��been paying attention, or��you’re��an optimist and think��there’ll��be a solution.��So, and��people might even pay their first bill thinking that��there’ll��be a solution next month, or that��we’re��close. I mean, I would think��there’d��be drop-off soon, but there might be a steeper��cliff a month or two from now, when people realize this is it for the year, and not just a tough, expensive month or two. So just because��they’re��not as bad as some��people��forecast��doesn’t��say that this is going to be a robust coverage year.��

Edney:��And I think,��I mean, they are the whole picture when you’re talking about who’s signing up, but a lot of these people that I’ve read about or heard about are on the radio programs and different things are signing up,��are drastically changing their lives to be able to afford what they think might be their insurance. So how does that play out��in other aspects?��I��think��will be��..��of the economy of jobs, like, where does that lead��us? I��think��will be something to watch out for too.��

Rovner:��And by the way, in case you’re wondering why health insurance is so expensive, we got the��, and total health expenditures grew by 7.2% from the previous year to��$5.3 trillion, or 18% of the nation’s GDP��[gross domestic product],��up from 17.7% the year before. Remember, these are the numbers for 2024,��not 2025,��but it makes��it��pretty��hard��for Republicans to blame the Affordable Care Act itself for rising insurance premiums. Insurance is more expensive because��we’re��spending more on health care.��It’s not really that complicated, right?��

Kenen:��This 17%-18% of GDP has been��pretty consistent, which��doesn’t��mean��it’s��good;��it just means��it’s��been around that level for many, many, many years. Despite all the talk about��how it’s��unsustainable,��it’s��been sustained,��with pain, but sustained.��$5.7 trillion,��even if��you’ve��been doing��this��a long time��…��

Rovner:��It’s��$5.3 trillion.��

Kenen:��$5.3 trillion.��It’s��a mind-boggling��number.��It’s��a lot of dollars!��So the ACA made insurance more��—��the out-of-pocket cost of insurance for millions of Americans, 20-ish million��—��but the underlying burden we’ve not solved��the — to use the word of the moment, the��“affordability”��crisis in health��care is still with us and arguably getting worse. But like, I think��we’re��sort of numb. These numbers are just so insane, and yet you say��it’s��unsustainable, but��…��I think it��was��Uwe’s��line, right?��

Rovner:��It was, it was a famous��Uwe��Reinhardt line.��

Kenen:��No,��it’s��sustainable, if��we’re��sustaining it at a high��—��in��economically��—��zany price.����

Rovner:��Right.��

Kenen:��And, like, the other thing is, like, where is the money?��Right? Everybody in health��care says they��don’t��have any money, so I��can’t��figure out who has the��$5 trillion.��

Rovner:��Yeah, well, it’s not��…��it does not seem to be the insurance companies as much as it is,��you know, if you look at these numbers��—��and I’ll post a link to them��—��you know, it’s hospitals and drug companies and doctors and all of those who are part of the health��care industrial complex, as I like to call��it.��

Kenen:��All��of them say they��don’t��have enough.����

Rovner:��Right.��All right. So we know that the Affordable Care Act subsidies are hung up over abortion, as Alice pointed out, and we know that the big abortion demonstration, the March for Life, is coming up next week, so I guess it shouldn’t be surprising that Senate��health��committee��chairman and ardent anti-abortion��senator Bill Cassidy would hold a hearing not on changes to the vaccine schedule, which he has loudly and publicly complained about, but instead about��the reputed dangers of the abortion pill,��mifepristone.��Alice, like me, you watched yesterday’s hearing. What was your takeaway?��

Ollstein:��So, you know, in a sense, this was a show hearing. There��wasn’t��a bill under consideration. They��didn’t��have anyone from the administration to grill. And��so��this is just��sort of your��typical��each side��tries to make their point hearing. And the bigger picture here is that conservatives, including senators and the activist groups who are sort of goading them on from the outside��—��they’re really frustrated right now about the Trump administration and the lack of action they’ve seen in this first year of this administration on their top priority, which is restricting the abortion pill.��Their bigger goal is outlawing all abortion,��but since abortion pills comprise the majority of abortions these days, that’s what they’re targeting.��And��so��they’re��frustrated that, you know, both��[Robert��F.]��Kennedy��[Jr.]��and��[Marty]��Makary have promised some sort of review or action on the abortion pill, and they say,��We��want to see it.��Why haven’t you done it yet?��And��so��I think that pressure��is only going to mount, and this hearing was part of that.��

Rovner:��I was fascinated by the Louisiana��attorney��general saying,��basically,��the��quiet part��out loud, which is that��we banned abortion, but because of these abortion pills, abortions are still going up in our state.��That was the first time I��think��I’d��heard an official say that. I mean that,��if you wonder why��they’re��going after the abortion pill,��that’s��why��—��because they��struck down��Roe��[v. Wade]��and assumed that the number of abortions would go down, and it really has not, has it?��

Ollstein:��That’s��right. And so not only are people increasingly using pills to��terminate��pregnancies, but��they’re��increasingly getting them via telemedicine.��And you know, that’s absolutely true in states with bans, but it’s also true in states where abortion is legal.��You know, a lot of people just really prefer the telemedicine option,��whether because��it’s cheaper, or they live really far away from a doctor who is willing to prescribe this, or, you know, any other reasons.��So��the right��—��you know, again, including senators like Cassidy, but also these activist groups��—��they’re��saying, at a bare minimum, we want the Trump administration to ban telemedicine for the pills and reinstate the in-person dispensing requirement. That would really roll back access across the country. But what they really want is for the pills to be taken off the market altogether. And��they’re��pretty open��about saying that.����

Rovner:��Well, rather��convenient timing from the��, which published a peer-reviewed study of 5,000 pages of documents from the FDA that found that over the last dozen years, when it comes to the abortion pill and its availability, the agency followed the evidence-based recommendations of its scientists every single��time, except once, and that once was during the first Trump administration.��Alice,��is there anything that will convince people that the scientific evidence shows that mifepristone is both safe and effective and actually has a very low rate of serious complications?��There were,��how many, like 100,��more than 100 peer-reviewed��studies that��basically��show��this,��plus the experience of many millions of women in the United States and around the world.��

Ollstein:��Well, just like��I’m��skeptical that��there’s��any compromise that can be found on the Obamacare subsidies,��there’s��just no compromise here. You know, you have the groups that are making these arguments about the pills’��safety say very openly that, you know, the reason they oppose the pills is because they cause abortions. They say it��can’t��be health care if��it’s��designed to end a life, and that kind of rhetoric. And��so��the focus on the rate of complication��…��I mean,��I’m��not saying��they’re��not genuinely concerned. They may be, but, you know, this is one of many tactics��they’re��using to try to curb access to the pills.��So��it’s��just one argument in their arsenal.��It’s��not��their,��like,��primary driving, overriding goal is, is the safety which, like you said, has been well��established��with many, many peer-reviewed studies over the last several years.��

Rovner:��So, in between these big, high-profile anti-abortion actions like Senate hearings, those supporting abortion rights are actually still prevailing in court, at least in the lower courts. This week, [a lawsuit filed by the American Civil Liberties Union and the National Family Planning and Reproductive Health Association against the Trump administration after the administration also quietly gave Planned Parenthood and other family planning groups] back the Title X family planning money that was appropriated to it by Congress. That was what Joanne was referring to, that Congress has been appropriating money that the administration hasn’t been spending. But this wasn’t really the big pot of federal money that Planned Parenthood is fighting to win back, right?

Ollstein:��It was one pot of money��they’re��fighting to win back. But yes, the much bigger Medicaid cuts that Congress passed over last��summer,��those are still in place. And so��that’s��an order of magnitude more than this pot of��Title��X��family planning money that they just got back. So that aside,��I’ve��seen a lot of conservatives conflate the two and accuse the Trump administration of violating the law that Congress passed and restoring funding to Planned Parenthood. This is different funding, and��it’s��a lot less than the cuts that happened. And so I talked to the organizations impacted, and it was clear that even though they’re getting this money back, for some it came too late, like they already closed their doors and shut down clinics in a lot of states, and they can’t reopen them with this chunk of money. This money is when you give a service to a��patient,��you can then��submit��for reimbursement. And��so��if the clinic’s not there,��it’s��not like they can use this money to, like, reopen the clinic, sign a lease, hire people, etc.����

Rovner:��Yeah.��The wheels of the courts, as we have seen, have moved very slowly.��

OK,��we’re��going to take a quick break. We will be right back.��

So��while abortion gets most of the headlines,��it’s��not the only culture war issue in play. The Supreme Court this week heard oral arguments in a case challenging two of the 27 state laws barring transgender athletes from competing on women’s sports teams. Reporters covering the argument said it seemed unlikely that��a majority of��justices would strike down the laws,��which would allow all of those bans to stand. Meanwhile, the other two branches of the federal government have also weighed in on the gender issue��in recent weeks.��The House passed a bill in December, sponsored by now former Republican��congresswoman��Marjorie Taylor Greene that would make it a felony for anyone to provide gender-affirming care to minors nationwide.��And the Department of Health and Human Services issued proposed regulations just before Christmas that��wouldn’t��go quite that��far, but��would have��roughly the��same effect. The regulations would ban hospitals from providing gender-affirming care to minors or risk losing their Medicare and Medicaid��funding, and��would bar funding for gender-affirming care for minors by Medicaid or the Children’s Health Insurance Program. At the same time, Health and Human Services Secretary Kennedy issued a declaration, which is already being challenged in court, stating that gender-affirming care, quote,��“does not meet professionally recognized standards of health care,”��and therefore practitioners who deliver it can be excluded from federal health programs. I get that sports��team��exclusions have a lot of public support, but does the public really support effectively ending all gender-affirming care for minors?��That’s��what this would do.��

Edney:��Well, I think that when a lot of people hear that, they think of surgery, which is the much, much, much, much, much less likely scenario here that��we’re��even talking about. And so those who are against it have done an effective job of making that��the issue. And so there��…��who support gender-affirming care, who have��looked into��it, would see that a lot of this is hormone treatment, things like that, to drugs��…����

Rovner:��Puberty blockers!��

Edney:��…��they’re taking��—��exactly��—��and so it’s not, this isn’t like a permanent under-the-knife type of thing that a lot of people are thinking about, and I think,��too,��talking about, like mental health, with being able to get some of these puberty blockers, the effect that it can have on a minor who doesn’t want to live the way they’ve been living, so it’s so helpful to them.��So��I think that there’s just a lot that has, you know, there’s been a lot of misinformation out there about this, and I feel like��that that’s kind of winning the day.��

Kenen:��I think,��like,��from the beginning, because, like, five or six years ago was the first time I wrote about this. The��playbook has been very much like the anti-abortion playbook. They talk about it in terms of protecting women’s health, and now��they’re��talking about it in protecting children’s health. And,��as Anna said,��they’re��using words like mutilation. Puberty blockers are not��mutilation. Puberty��blockers are a medication that delays the onset of puberty, and it is not irreversible.��It’s��like a��brake. You take your foot off the brake,��and puberty starts.��There’s��some controversy about what age and how long, and��there’s��some��possible bone��damage. I mean, there’s some questions that are raised that need to be answered, but the conversation that’s going on now��—��most of the experts in this field, who are endocrinologists and psychologists and other people who are working with these kids,��cite a lot of data saying that not only this is safe, but it’s beneficial for a kid who really feels like they’re trapped in the wrong body.��So��you know, I think it’s really important to repeat��…��the point that Anna made, you know, 12-year-olds are not getting major surgery.��Very few minors are, and when they are,��it’s��closer��… they��may be under 18,��it’s��rare. But if��you’re��under 18,��you’re��closer to 18,��it’s��later in��teens. And��it’s��not like you walk into an operating room and say, you know,��do this to me.��There’s��years of counseling and evaluation and professional teams. It really did strike a nerve in the campaign. I think Pennsylvania,��in particular.��This is something that people��don’t��understand and get��very upset��about, and the inflammatory��language,��it’s��not creating understanding.��

Rovner:��We’ll��see how��this one plays��out. Finally, this week, things at the Department of Health and Human Services��continues��to be chaotic. In the latest round of��“we’re cutting you off because you don’t agree with us,”��the Substance Abuse and Mental Health Services Administration sent hundreds of letters Tuesday to grantees��canceling��their funding��immediately.��It’s��not entirely clear how many grants or how much money was involved, but it��appeared to be��something��in the neighborhood of��$2 billion��—��that’s��around a fifth of SAMHSA’s��entire budget. SAMHSA, of course, funds programs that provide addiction and mental health treatment, treatment for homelessness and suicide prevention, among other things. Then,��Wednesday night, after a furious backlash from Capitol Hill and��just about every��mental health and substance abuse group in the country, from what I could tell from my email, the administration canceled the cuts.��Did they miscalculate the scope of the reaction here, or was chaos the actual goal in this?����

Edney:��That is��a great question. I really��don’t��know the answer. I don’t know what it could serve anyone by doing this and reversing it in 24 hours, as far as the chaos angle, but it does seem, certainly,��like there was a��miscalculation of how Congress would react to this, and it was a bipartisan reaction that wanted to know why, what is it even your justification? Because these programs do seem to support the priorities of this administration and HHS.��

Rovner:��I��didn’t��count, but I got dozens of emails yesterday.����

Edney:��Yeah.��

Rovner:��My entire email box was overflowing with people��basically freaking��out about these cuts��to SAMHSA. Joanne,��you wanted��to say something?��

Kenen:��I think that one of the shifts over��—��I’m not exactly sure how many years��—��7,��8,��9, years, whatever we’ve been dealing with this opioid crisis, the country has really changed and how we see addiction, and that we are much more likely to view addiction not as a criminal justice issue, but as a mental health issue.��It’s��not that everybody thinks that.��It’s��not that every lawmaker thinks that, but we have really turned this into, we��have seen it as, you know, a health problem and a health problem that strikes red states and blue states. You know, we are all familiar with the��“deaths of despair.”��Many of us know at least an acquaintance or an acquaintance’s family that have experienced an overdose death. This is a bipartisan shift. It is,��you know,��you’ve��had plenty of conservatives speaking out for both more money and more compassion. So I think that the backlash yesterday, I mean, we saw the public backlash, but I think there was probably a behind-the-scenes��—��some of the��“Opioid��Belts”��are very conservative states,��and Republican governors, you know, really saying we’ve had progress.��Right? The last couple of years, we have made progress. Fatal overdoses have gone down, and Narcan is available. And just like our inboxes, I think their��telephones, they��were bombarded.����

Rovner:��Yeah.��Well, meanwhile, several��hundred��workers have��reportedly been��reinstated at the National Institute of Occupational Safety and Health��—��that’s��a��subagency of CDC��[the Centers for Disease Control and Prevention].��Except that those RIF��[reduction in force]��cancellations came nine months after the original RIFs, which were back in April. Does the administration think these folks are just sitting around waiting to be called back to work?��And in news from the National Institutes of Health,��Director Jay Bhattacharya told a podcaster last week that the DEI-related��[diversity, equity, and inclusion]��grants that were canceled and then reinstated due to court orders are likely to simply not be renewed. And at the FDA, former longtime drug regulator Richard��Pazdur��said at the J.P.��Morgan��[Healthcare] Conference in San Francisco this week that the��firewall��between the political appointees at the agency and its career��drug reviewers has been,��quote,��“breached.”��How is the rest of HHS expected to actually, you know, function with even so much uncertainty about who works there and who’s calling the shots?��

Ollstein:��Not to mention��all of��this back and forth and chaos and starting and stopping is costing more,��is costing taxpayers more.��Overall spending is up. After all of the��DOGE��[Department of Government Efficiency]��and��RIFs��and all of it, they have not cut spending at all because it’s more expensive to pay people to be on administrative leave for a long time and then try to bring them back and then shut down a lab and then reopen a lab. And all of this has not only meant, you know, programs not serving people, research not happening, but it��hasn’t��even saved the government any money, either.��

Kenen:��Like, you know, the game we played when we were kids, remember,��“Red��Light-Green��Light,”��you know, you’d��run in one direction, you run back. And if you were��8��years old, it would end with someone crying. And that’s��sort of the��way��we’re��running the government��these��days��[laughs].��The amount of people fired, put on leave. The CDC has had this incredible yo-yoing of people. You��can’t��even keep track. You��don’t��even know what email to use if��you’re��trying to��keep��in��touch��with them��anymore. The churn,��with what logic?��It’s, as Alice said,��just��more expensive, but it’s,��it’s��also just��…��like��you��can’t��get your job done.��Even if you want a smaller government, which many of conservatives and Trump people do,��you still want certain functions fulfilled.��But there’s still a consensus in society that we need some kind of functioning health system and health oversight and health monitoring.��I mean, the American public is not against research, and the American public is not against keeping people alive.��You know, the inconsistency is pretty mind-boggling.��

Edney:��Well, there’s a lot of rank-and-file, but we’re seeing a lot of heads of parts of the agencies where, like at the FDA, with the drug center, or many of the different institutes at NIH that really don’t have anyone in place that is leading them. And I think that that, to me, like this is just my humble opinion, is��it��kind of seems��like the message as��anybody can do this part, because��it’s��all coming from one place. There’s really just one leader, essentially, RFK, or maybe it’s Trump, or they want everyone to do it the way that they’re going to comply with the different,��like you said, everyone wants research, but I,��Joanne, but I do think they only want certain kinds of research in this case.��So��it’s��been interesting to watch how many leaders in these agencies that are going away and not being replaced.��

Rovner:��And all the institutional memory��that’s��walking out the door. I mean,��more people��—��and to��Alice’s point about how this��hasn’t��saved money��—��more people have taken early retirement than have��been actually, you��know,��RIF’d��or fired or let go. I mean, they’ve just��…��a lot of people��have basically, including��a lot of leaders of many of these agencies, said,��We��just��don’t��want to be here under these circumstances.��Bye.��Assuming at some point this government does want to use the Department of Health and Human Services to get things done,��there might not be the personnel around to actually effectuate it.��But we will continue to watch that space.��

OK, that’s this week’s news. Now we will play my��“Bill of the��Month”��interview with Elisabeth Rosenthal, and then we will come back and do our extra credits.��

I am pleased to welcome back to the podcast Elisabeth Rosenthal, senior contributing editor at��KFF��Health��News and originator of our��“Bill of the Month”��series, which in its��nearly eight��years has analyzed��nearly $7 million��in dubious, infuriating,��or inflated medical charges. Libby also wrote the latest��“Bill of the��Month,”��which��we’ll��talk about in a minute. Libby, welcome back to the podcast.��

Elisabeth Rosenthal:��Thanks for having me back.��

Rovner:��So��before we get to this month’s patient, can you reflect for a moment on the impact this series has had, and how frustrated��are you that eight years on,��it’s��as relevant as it was when we began?��

Rosenthal:��We were��worried it��wouldn’t��last a year, and here we are, eight years later, still finding plenty to write about. I mean,��we’ve��had some wins.��I think we��helped contribute to the��No��Surprises��Act being passed.��There are��states clamping down on facility fees, you know, and making sure that when you get something done in a hospital rather than an outpatient clinic,��it’s��the same cost. The��country’s��starting to address drug prices.��But,��you know, we��seem to be��the billing��police, and��that’s��not good.��We’ve��gotten a lot of bills written off for our individual patients. Suddenly, when a reporter calls,��they’re��like,��Oh, that was a mistake��or��Yeah,��we’re��going to write that off. And��I’m��like,��You’re��not writing that off;��that��shouldn’t��have been billed. So sadly, the series is still going strong, and medical billing has proved endlessly creative. And you know, I think the sad thing for me is our success is a sign of a deeply, deeply dysfunctional system��that��has��left,��as we know, you know, 100 million adult Americans with medical debt.��So��we will keep going until��it’s��solved,��I hope.��

Rovner:��Well, getting on to this month’s patient, he gives new meaning to the phrase��“It must have been something I ate.”��Tell us what it was and how he ended up in the emergency room.��

Rosenthal:��Well, Maxwell��[Kruzic]��loves eating spicy foods, but��he’s��never had a problem with it. And suddenly, one night, he had just��excruciating, crippling abdominal pain. He drove himself to the emergency room. It was so bad he had to stop three times, and when he got there, it was mostly on the right-lower quadrant. You know, the doctors were so convinced, as he was, that he had appendicitis, that they called a surgeon right away, right?��So��they were all��like,��ready to go to the operating room. And then the scan came back, and it was like,��whoops,��his appendix is normal. And then,��oh, could he have kidney stones?��And��it’s��like no sign of that either. And finally, he thought, or someone asked,��Well, what did you eat last night?��And of course, Maxwell had ordered the hottest chili peppers from a bespoke chili pepper-growing company in New Mexico. They have some chili pepper rating of 2 million��[Scoville heat units], which is,��like,��through the roof, and it was a reaction to the chili peppers.��I didn’t even know that could happen, and I trained as a doctor, but I guess your intestines don’t like really, really, really hot stuff.��

Rovner:��So��in the end, he was��OK.��And the story here isn’t even really about what kind of care he got, or how much it cost.��The $8,000 the hospital charged for his few hours in the ER��doesn’t��seem all that out of line compared to some of the bills��we’ve��seen.��What was most notable in this case was the fact that the bill didn’t actually come until two years later.��How much was he asked to pay two years after the hot pepper incident?��

Rosenthal:��Well, he was asked to pay a little over $2,000,��which was his coinsurance for the emergency room visit. And as he said, you know, $8,000��…��now we go,��well,��that’s��not bad.��I mean, all they did,��actually, was do a couple of scans and give him some IV fluids.��But��in this day and age,��you’re��like, wow, he got away��— you know, from��a��“Bill of a��Month”��perspective, he got away cheap, right?��

Rovner:��But I would say, is it even legal to send a bill two years after the fact? Who sends a bill two years later?��

Rosenthal:��That’s��the problem,��like,��and Maxwell��—��he’s��a pretty smart guy, so he was checking his portal repeatedly. I mean, he paid something upfront at the ER, and he kept��thinking,��I must owe something. And he checked and he��checked��and he checked and it kept saying zero. He actually called his��insurer and��to make sure that was right. And they said,��No, no, no,��it’s��right. You owe zero. And then, you know, after like, six months, he thought,��I guess I��owe zero. But then he��didn’t��think about it, and then almost two years later, this bill arrives in the mail, and��he’s��like,��What?!��And what I discovered, which is a little disturbing, is it is not, I wouldn’t say normal, but we see a bunch of these ghost bills at��“Bill of the��Month,”��and in many cases, it’s legal, because��of��what was going on in those two-year periods. And of course, I called the hospital, I called the insurer, and they were like,��Yeah, you know, someone was away on vacation, and someone left their job, and we��couldn’t��…��you know, the hospital��billed them��correctly. And the hospital said,��No, we��didn’t.��And they were just��kind of doing��the usual��back-end negotiations to figure out what a service is worth.��And when they finally agreed two years later��what should be paid,��that’s��when they sent Maxwell the bill. And the problem��is,��whether��it’s��legal really depends on your insurance contracts, and whether they allow this kind of late billing.��I do not know to this day if Maxwell’s did, because as soon as I called the insurer��and��the hospital, they were like,��Never��mind. He��doesn’t��owe��anything. And you know, as he said,��he’s��a geological engineer. He has lots of clients, and as he said, you know, if I called them two years later and said,��Whoops, I forgot to bill for something, they would be like,��Forget��it!��you��know.��So��I do think this is something that needs to be addressed at a policy level, as we so often discover on��“Bill of the��Month.”��

Rovner:��So��what should you do if you get one of these ghost bills? I should say��I’m��still negotiating bills from a surgery that I had six months ago.��So��I guess I should��count��myself lucky.��

Rosenthal:��Well, I think you should check with your insurer and check with the hospital. I think more��with��your insurer��—��if the contract says this is legal to bill.��It’s��unclear��to me,��in this case, whether it was.��The hospital was very much like,��Oh, we made a mistake;��because it took so long,��we��actually��couldn’t��bill Maxwell.��So��I think in his case, it��probably was��in the contract that this was too late to��bill. But, you know, I think a lot of hospitals, I hate to say it, have this attitude.��Well,��doesn’t��hurt to try, you know,��maybe��they’ll��pay��it. And people are afraid of bills, right? They��pay��them.����

Rovner:��I know the feeling.��

Rosenthal:��Yeah, I do think, you know, they should check with their insurer about whether there’s a statute of limitations,��essentially,��on billing, because there may well be and I would say it’s a great asymmetry, because if you submit an insurance claim more than six months late, they can say,��Well, we won’t pay this.��

Rovner:��And just to tie this one up with a bow, I assume that Maxwell has changed his pepper-eating ways, at least��modified��them?��

Rosenthal:��He said he will never eat��scorpion peppers again.��

Rovner:��Libby Rosenthal, thank you so much.��

Rosenthal:��Oh, sure.��Thanks��for having me.��

Rovner:��OK,��we’re��back, and now��it’s��time for our��extra-credit��segment.��That’s��where we each recognize a story we read this��week��we think you should read,��too.��Don’t��worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Anna, why don’t you start us off this week?��

Edney:��Sure.��So��my extra credit is from��MedPage��Today:��“.”��I appreciated this article because it answered some questions that I had,��too,��after the sweeping change to the childhood vaccine schedule. There��was��just a lot of discussions I had about, you know, well, what does this really mean on the ground? And will��parents��be confused? Will pediatricians��—��how will they be talking about this? You know, will they stick to the schedule we knew before? And there was an article in JAMA��Perspectives��that lays out, essentially, to��clinicians, you know, that they should not fear malpractice��..��issues if��they’re��going to talk about the old schedule and not adhere to the newer schedule. And��so��it lays out some of those issues.��And I thought that was really helpful.��

Rovner:��Yeah, this was a big question that I had,��too.��Alice, why don’t you go next?��

Ollstein:��Yeah, so I have a piece from ProPublica.��It’s��called��“.”��So��this is about how��there’s��been this huge push on the right to end public water fluoridation that has succeeded in a��couple��places and could spread more. And the proponents of doing that say that��it’s��fine because there are all these other sources of fluoride. You can get��a treatment��at the��dentist,��you can get it in stuff you buy at the drugstore and take yourself. But at the same time, the people who��arepushing��for ending fluoridated public drinking water��are also pushing for restricting those other sources. There have been state and federal efforts to crack down on them, plus��all of��the just rhetoric about fluoride, which is very misleading. It misrepresents studies about its alleged��neurological impacts. But it also,��that kind of rhetoric makes people afraid to have fluoride in any form, and people are very worried about that, what��that’s��going to do to the nation’s teeth?��

Rovner:��Yeah,��it’s��like vaccines. The more you��talk��it��down,��the less people want to do it.��Joanne.��

Kenen:��This is��a piece by��Dhruv Khullar��in��The New Yorker called��“,”��and it was really great, because there’s certain things I think that we who��—��like, I don’t know how all of you watch it��—��but like, there’s certain things that didn’t even strike me, because I’m so used to writing about, like, the connection between poverty, social determinants of health, and, like, of course, people who come to the ED��[emergency department]��have, you know, homelessness problems and can’t afford food and all that. But��Dhruv��talked��about��how it��sort��of brought that home to him, how our social safety net, the holes in it, end up in our��EDs.��And he also talked about some of it is dramatized more for TV, that not everybody’s heart stops every 15 minutes. He said that sort of happens to one patient��a��day. But he talked about compassion and how that is rediscovered in this frenetic ED/ER��scene.��It’s��just a very thoughtful piece about why we all love that TV show. And��it’s��not just because of��Noah Wyle.��

Rovner:��Although that helps. My extra credit this week is from��The New York Times.��It’s��called��“,” by Maxine��Joselow.��And while it’s not about HHS, it most definitely is about health.��It seems that for the first time in literally decades, the Environmental Protection Agency will no longer calculate the cost��to��human health when setting clean air rules for ozone and fine particulate matter, quoting the story:��“That would most likely lower costs��for companies while resulting in dirtier air.”��This is just another reminder that the federal government is��charged with ensuring the help of Americans from a broad array of agencies, aside from HHS��—��or in this case, not so much.����

OK, that’s this week’s show.��As always, thanks to our editor, Emmarie��Huetteman,��and our producer-engineer, Francis Ying.��We also had��help��this week from producer Taylor Cook.��A��reminder:��What the��Health?��is now available on WAMU platforms, the NPR app,��and wherever you get your podcasts, as well as, of course, at��kffhealthnews.org.��Also, as always, you can email us your comments or questions.��We’re��at��whatthehealth@kff.org,��or you can find me still on X��, or on Bluesky��.��Where are you folks hanging these days?��Alice.��

Ollstein:��Mostly��on��Bluesky����and still on��X��.��

Rovner:��Joanne.��

Kenen:��I’m��mostly on����or on����.��

Rovner:��Anna.��

Edney:����or��X��.��

Rovner:��We will be back��in your feed next week. Until then, be healthy.��

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Treatment for a Florida Medicaid enrollee’s heart attack cost nearly $78,000 — about as much as surgery for an uninsured Montana woman’s broken arm.

In 2025, these patients were among the hundreds who asked ���ϳԹ��� News to investigate their medical bills as part of its “Bill of the Month” series.

Insured and uninsured. Job-based and government-funded. Comprehensive and short-term. Part of a sharing ministry. So many people with different health insurance situations asked the same questions: Why do I owe so much? And how am I going to afford it?

As millions of Americans grapple with the rising cost of health insurance next year, the “Bill of the Month” series is approaching its eighth anniversary. Our nationwide team of health reporters has analyzed almost $7 million in medical charges, more than $350,000 of that this year.

Of this year’s 12 featured patients, five had their bills mostly or fully forgiven soon after we contacted the provider and insurer for comment.

Our mission, though, is to empower every patient with the information needed to understand, manage, and — if push comes to shove — fight their own medical bills. Here are our 10 takeaways from 2025.

1. Most insurance coverage doesn’t start immediately. Many new plans come with waiting periods, so it’s important to maintain continuous coverage until the new plan kicks in. One exception: If you lose your job-based coverage, you have 60 days to opt into . Once you pay, the coverage applies retroactively, even for care received while you were temporarily uninsured.

2. Check out your coverage before you check in. Some plans come with unexpected restrictions, potentially affecting coverage for care ranging from contraception to immunizations and cancer screenings. Call your insurer — or, for job-based insurance, your human resources department or retiree benefits office — and ask whether there are exclusions for the care you need, including per-day or per-policy-period caps, and what you can expect to owe out-of-pocket.

3. “Covered” does not mean insurance will pay, let alone at in-network rates. Carefully read the fine print on network gap exceptions, prior authorizations, and other insurance approvals. The terms may be limited to certain doctors, services, and dates.

4. Get a cost estimate in writing for nonemergency procedures. If you object to the price, negotiate before undergoing care. And if you’re uninsured and receive a bill that’s $400 or more than the estimate, the federal Centers for Medicare & Medicaid Services has a .

5. Location matters. Prices can vary depending on where a patient receives care and where tests are performed. If you need blood work, ask your doctor to send the requisition to an in-network lab. A doctor’s office connected to a health system, for instance, may send samples to a hospital lab, which can mean higher charges.

6. When admitted, contact the billing office early. If possible, when you or a loved one has been hospitalized, it can help to speak to a billing representative. Ask whether the patient has been fully admitted or is being kept under observation status, as well as whether the care has been determined to be “medically necessary.” And while there may be no choice about taking an ambulance, if a transfer to another facility is recommended, you can ask whether the ambulance service is in-network.

7. Ask for a discount. Medical charges are almost always higher than what insurers would pay, because providers expect them to negotiate lower rates. You can, too. If you’re uninsured or underinsured, you may be eligible for a self-pay or charity care discount.

8. There’s help available for Medicaid patients. If you get a bill you don’t think you should owe, file a complaint with your state’s Medicaid program and, if you have one, your managed-care plan. Ask whether there is a caseworker who can advocate on your behalf. A legal aid clinic or consumer protection firm specializing in medical debt can also help file complaints and communicate with providers.

9. Your elected representatives can help, too. While a call from a state or federal lawmaker’s office may not get your bill forgiven, those officials often have an open line of communication with insurance companies, local hospitals, and other major providers — and advocating for you is their job.

10. When all else fails … you can write to “Bill of the Month”!

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Bill of the Month is a crowdsourced investigation by ���ϳԹ��� News and that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it!

���ϳԹ��� 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 .

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The nurse who took the call at the Sono Bello center in Addison, Texas, told her she “absolutely should not” go to the ER — even though Farris “had a large gush of foul fluid” leaking from the incision, according to records in the malpractice case she filed against the cosmetic surgery chain in 2024.

The nurse told Farris she “only needed to reinforce her dressing to collect the fluid drainage and give it time,” filings in the lawsuit alleged.

“Thankfully, Ms. Farris did go to the ER where she was diagnosed with sepsis from her surgery complications,” a medical expert for her legal team wrote in a court filing. Left untreated, sepsis can lead to death.

Sono Bello officials declined to discuss malpractice cases filed against the company, citing patient privacy laws. But in court filings, the company has disputed Farris’ claims. The case is set for trial early next year.

The Farris lawsuit is one of dozens of medical malpractice cases filed over the past three years that accuse cosmetic surgery chains of failing to provide adequate care for patients in the days and weeks after their procedures — in many cases by allegedly neglecting to promptly treat painful infections and other serious complications — including for four patients who died, a ���ϳԹ��� News investigation found.

In some cases, patients who traveled hundreds of miles or more for seemingly routine surgeries allegedly suffered painful complications while recuperating in hotel rooms or unlicensed “recovery homes,” which they said lacked adequate medical staff and supervision, according to court filings.

While complications, such as infections, can occur after any surgical procedure, problems related to postoperative care are blamed for contributing to injuries in over two-thirds of the cosmetic surgery cases ���ϳԹ��� News reviewed.

The surgery companies involved — some, like Sono Bello, financed by — offer elective procedures such as liposuction and “” to patients who pay thousands of dollars out-of-pocket or on credit. Ads promise life-changing body reshaping techniques with minimal risk and .

Medical malpractice lawsuits have trailed behind the growth of these companies. Suits have accused the chains of hiring doctors who lacked adequate training or had , and of using high-pressure sales tactics and misleading advertising pitches that downplay safety risks, court records show. The companies dispute these allegations and have won dismissal of some suits.

Patrick Schaner, a plastic surgeon and a Sono Bello medical director, stressed that the company has performed more than 300,000 cosmetic operations with minimal complications. “That context is very important,” he said in an interview.

Schaner said Sono Bello surgeons are “good at what they do” because of the large numbers of procedures they perform. “We do a great job of getting safety protocols in place,” he said.

Many patients who file lawsuits blame disfiguring injuries on what happened after their operations, such as office visits in which medical staff allegedly didn’t recognize, or dismissed, evidence of worsening surgical complications, court records show.

A nurse at a Sono Bello center outside Chicago allegedly failed to alert doctors when Mary Anne Garcia, a patient who had had liposuction at the center about three weeks earlier, showed up there with her aunt. Garcia was dizzy and so weak she required a wheelchair to get back to the car, according to a lawsuit her estate filed in September.

Rather than tell Garcia to go to an emergency room, the Sono Bello nurse told her to “drink more fluids and try to eat something,” according to the complaint.

Garcia died the next day from cardiac arrest, according to the lawsuit. Sono Bello has yet to file a response to the lawsuit in court.

‘It Was Horrifying’

Susan Easley, 59, a veteran U.S. Agency for International Development executive who spent two decades working on AIDS projects in Africa, died in a Washington, D.C., short-term apartment last year.

Her son Gavin found her body May 13, 2024, four days after she had an AirSculpt liposuction and fat transfer operation at Elite Body Sculpture in nearby Vienna, Virginia, according to a lawsuit filed in November.

“It was horrifying,” Gavin Easley told ���ϳԹ��� News in an interview. “My mother was the definition of kind, caring, and unconditionally loving. She was the most incredible woman I’ve ever known,” said Easley, 29, who runs an organic farm in Arkansas with his wife.

The suit alleges that surgeon Dare Ajibade gave Easley an excessive amount of the anesthetic lidocaine during the 6½-hour procedure and failed to recognize persistent vomiting afterward as a sign of toxicity. She called the clinic to report her condition, but her concerns were dismissed, the suit alleges.

“When she called to report complications, they didn’t take it seriously,” said Virginia attorney Peter Anderson, who filed the suit. He said Easley presented “clear signs and symptoms” of problems.

is a brand of Elite Body Sculpture, a Miami Beach-based chain founded by cosmetic surgeon Aaron Rollins. The company, which is financed by private equity investors, has about 30 branches across the country. Neither the company nor Rollins responded to repeated requests for comment on patient lawsuits. In court filings, the company has denied the allegations.

Ajibade has since relocated to Texas, where he works for Sono Bello in San Antonio, according to the company. Neither the surgeon nor the Virginia surgery office, which is also a defendant in the case, returned calls for comment. The defendants have yet to file an answer in court.

A Booming Business

Sono Bello, with more than 100 centers nationwide, bills itself as “America’s #1 Cosmetic Surgery Specialist.”

Patients filed seven malpractice cases against Sono Bello in September — each in a different state. In an interview, Marcy Norwood Lynch, a Sono Bello executive vice president and chief legal officer, speculated that the spurt in cases was related to reporting by ���ϳԹ��� News and NBC News about the company. There “could be alignment” between the coverage and the filing of the suits, she said. The company has denied the allegations in court.

���ϳԹ��� News reviewed a sample of more than 100 medical malpractice cases filed against multistate surgery chains from the start of February 2023 through November 2025. Malpractice suits do not by themselves prove substandard care, though many medical authorities and licensing boards consider them a tool for helping to judge medical quality.

Heather Faulkner, a plastic surgeon and associate professor at Emory University School of Medicine in Atlanta, said surgeons must quickly recognize before they progress and become serious, even life-threatening conditions.

At Emory, she said, surgeons must attend their patients’ first visit after cosmetic surgery. “Ultimately, the physician is the one responsible,” she said. “The patient has to be seen by the person who did the operation and knows how to recognize something is wrong,” Faulkner said in an interview.

Patients suing cosmetic surgery chains often argue that they were seen by nurses or other staff members who, they allege, lacked the training to recognize and deal with problems before they required emergency wound care.

Schaner, the Sono Bello medical director, said the company has a phone messaging system that ensures patients can get in touch with their surgeon or other company physicians. While nurses see some patients, the “ultimate decision-making is passed to the surgeon,” he said.

Five patients treated at Sono Bello centers who sued the company during 2025 alleged that surgical wound complications were dismissed after medical staff, including surgeons, viewed pictures of the injuries, court records show. The cases are pending.

Schaner said Sono Bello sometimes has patients submit photos of wounds but the images are “not the sole means of triage” of patient injuries or complications.

Joshua Kiernan sued Sono Bello after having liposuction on May 28, 2024, at the branch in Columbia, South Carolina. On June 8, 2024, he stumbled and fell in a gym parking lot, causing drainage around the incision in his stomach, according to the suit. On June 17, 2024, Kiernan visited the office complaining of “redness and pain” around the incision, according to his suit.

The surgeon, Stancie Rhodes, didn’t examine him in person but had an office staff member take a picture “so that she could view it from another part of the office,” according to the complaint.

The surgeon sent back word that the photo “looked fine,” and Kiernan was told to take Tylenol for the pain and follow up at the office a week later, the complaint alleged.

Two days before his appointment, Kiernan required emergency hospital treatment for “abdominal hematoma and infection,” according to the suit.

Kiernan underwent six surgical procedures and ran up medical bills of more than $325,000 to treat his condition, according to the suit. In court filings, Sono Bello denied the allegations.

“Surgical care does not end at the last stitch,” said Mark Domanski, a plastic surgeon in Virginia, who believes the chain clinics in general are more adept at marketing than providing patients with top-notch care. “It involves postoperative visits with the surgeon who did the procedure, who is there to respond to the patient’s concerns, questions, especially if things are not going well,” he said.

Recovery Houses

Many patients who travel for cosmetic surgery, either to save money or because services aren’t available in their area, can’t return home right away.

Yet there’s little agreement on where patients should recuperate, for how long, and what medical services should be readily available to them.

Scott Hollenbeck, immediate past president of the American Society of Plastic Surgeons, said laws or regulations in most states don’t spell out requirements.

“This can create a wide variation of oversight, staff qualifications, and available medical support,” he said.

The plastic surgery society has a cottage industry of recovery houses that often charge patients hundreds of dollars a night while they recuperate, even though they may lack medical staff capable of handling possible surgical complications.

Court filings in Florida show patients staying in recovery houses and hotels have died or suffered untreated complications, mostly in South Florida, where officials have struggled for a decade or more to regulate unlicensed facilities. One local lawmaker recently to rein them in.

Hollenbeck said patients who recuperate in a hotel or other facility need to find out in advance what “level of care” will be available. He said ads touting “luxury” accommodations or “conveniently located” do not make a hotel “clinically qualified to provide recovery care.”

Easley, whose mother died in Washington, D.C., said he is struggling to understand what happened after a medical transportation service took her from the Virginia surgery center to a temporary apartment.

He said his mother, who was born in a small village in Uganda before emigrating to the U.S. as a teen and joining the U.S. Army, “had so many plans” for the future.

Susan Easley had been medically cleared for a . After that, she planned to retire and start a farm in Tanzania, among other things, according to her son.

The lawsuit alleges the surgery center discharged her prematurely given signs of a dangerous condition called caused by an overdose of lidocaine.

Susan Easley called the surgery center that day and reported “multiple instances of nausea and vomiting,” but there’s “no evidence” that anyone told her to head to an emergency room, according to the suit.

“I don’t know what they said to her,” Gavin Easley said. “It’s a horrifying thought for me. I have no idea how to get to the bottom of that mystery.”

‘Preventable Death’

Some lawsuits take aim at decisions made by support staff members, who help monitor patients after surgery.

That’s a critical issue in the case of Mary Anne Garcia, the Illinois woman who died after her aunt drove her to the Sono Bello office in Oakbrook Terrace, Illinois, on June 4, 2024.

Garcia “was feeling sluggish, dizzy, and nauseated,” according to the suit. She also had a rapid heartbeat and low blood pressure, according to the complaint. But registered nurse Lucia Raddatz did not notify the surgeon or urge Garcia to seek emergency care even though Raddatz had to help her back to the car in a wheelchair due to Garcia’s “severely weakened condition,” according to the suit.

Filed on behalf of Garcia’s estate, the suit names Raddatz and Sono Bello as defendants. An emergency room physician hired as an expert in the case opined that had Garcia gone to the emergency room on June 4, “she would have received care which would have avoided her death,” court records state. Sono Bello had no comment and has yet to file an answer in court.

Established plastic surgeons say they are often called upon to treat patients who arrive in the emergency room with complications because surgeons working for the chains may lack local hospital privileges or are otherwise not available for consultations.

“There is not one colleague of mine who has not dealt with the complications of these types of facilities or med spas on more than one occasion,” said Charles Pierce, president-elect of the New Jersey Society of Plastic Surgeons.

‘Angry and Betrayed’

Doctors at an Austin, Texas, hospital expressed such frustration while caring for Anna Palko, a 33-year-old mother of four, according to a malpractice suit she filed in November against surgeon Rambod Charepoo and his employer, Mia Aesthetics. The Miami-based cosmetic surgery company, which operates in about a dozen cities, including Austin, advertises that it delivers the .

A doctor at St. David’s Medical Center in Austin wrote in Palko’s medical record: “Unfortunately patient has had postoperative complications from a physician who is well-known to our emergency department for similar post-op complications associated with cosmetic surgery through MIA (sic) Aesthetics,” according to the suit.

Palko is one of five Texas women who sued Charepoo and Mia Aesthetics for malpractice this year, between mid-July and the end of November, court records show.

Four women allege the surgeon and the company failed to adequately treat infections that developed after surgery, while the fifth alleged other complications. Mia Aesthetics was dismissed from one case. The surgeon and the company have denied the allegations in court filings, court records show.

Charepoo also has been the subject of a lengthy investigation by the Texas Medical Board, which licenses doctors.

In August 2021, the board alleged that the surgeon “failed to meet the standards of care” in treating six patients, including one he placed “at risk” by allowing the patient to leave the surgery center for the emergency room in a private vehicle after the person “experienced significant hypotension and hemorrhagic shock.”

In October 2024, the medical board found that Charepoo had failed to meet standards of care for five of the six patients. The board required him to have a surgical proctor oversee 20 of his operations per quarter for two years. The board also ordered him to take medical education courses, pass an exam, and pay a fine of $4,000.

Charepoo is fighting the order in court. Charepoo, Mia Aesthetics, and lawyers representing Charepoo and the company did not respond to requests for comment.

In January, he sued the Texas Medical Board, arguing the penalty is “both excessive and unjustified” and should be invalidated. The medical board declined to comment on the suit, which is pending in Travis County District Court.

Hearing of the surgeon’s problems came as a shock to patient Palko, who said she had chosen Mia Aesthetics because of ads promising high-quality doctors.

“I felt so disgusted, angry, and betrayed,” Palko said in an email sent through her attorney.

Have you had liposuction, a “Mommy Makeover,” a tummy tuck, a Brazilian butt lift, or another type of cosmetic surgery? We’d like to hear about your experience. Click here to contact our reporting team.

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Kruzic was seen immediately because hospital staff members were pretty sure he had appendicitis. They inserted an IV, called a surgeon, and sent him off for a scan to confirm the diagnosis.

But the scan showed a perfectly normal appendix and no problems in his abdomen. Doctors racked their brains for other possible diagnoses. Could it be a kidney stone? Gallstones? Here was a 37-year-old man in agony, but nothing really fit.

Then, someone asked what Kruzic had eaten the night before. He said he’d consumed tacos with some hot sauce that he’d made from a kind of scorpion pepper, grown from seeds he ordered from a chile pepper research institute.

The peppers measure over 2 million Scoville heat units on the spiciness scale, he noted, compared with a jalapeño at up to 8,000 or a habanero at 100,000 to 350,000.

The peppers are among “the world’s hottest, incredibly hot,” Kruzic said. “Delicious.” He loves spicy food and had never had a problem with it, but apparently this was just too much burn for his digestive system.

Kruzic spent much of the night on a gurney in the ER. After about four hours, the pain decreased, and he was sent home with medicine to treat nausea and vomiting.

Then the bill came — about two years later.

The Medical Procedure

Kruzic underwent blood work and a CT scan of his abdomen during his ER visit for acute abdominal pain.

Consuming very spicy foods painful inflammation and irritation of the digestive system. The discomfort typically resolves on its own.

The Final Bill

$8,127.41, including $5,820 for the CT scan. Kruzic paid $97.02 during his visit to the hospital, which was in-network under his insurance. After insurance payments and discounts, he owed $2,460.46 — the remainder of the $1,585.26 he owed toward his plan’s deductible and $972.22 he owed in coinsurance.

The Problem: Ghost Bills From Visits Past

This September, Kruzic received a bill for his pepper-induced ER visit in 2023.

Unfortunately for patients, there are no uniform rules for timely billing.

Anticipating a bill, Kruzic repeatedly checked the hospital’s online portal, as well as that of his insurer, UnitedHealthcare. He noted that the insurer said the claim had been processed shortly after his treatment. For about eight months, he kept checking the hospital portal’s billing section, which indicated he owed “$0.” He called UnitedHealthcare, and Kruzic said a representative assured him that if the hospital said he owed nothing, that was the case.

It is unclear what caused the nearly two-year delay. At least part of the problem seems to have involved protracted disagreements between the insurer and the hospital over how much his visit should have cost.

Lindsay Radford Foster, a spokesperson for CommonSpirit Health, the hospital system, said in a statement to ���ϳԹ��� News: “United Healthcare, the insurer responsible for the medical claim, underpaid the account based on the care provided. As a result, CommonSpirit contacted UnitedHealthcare’s Payer Relations Department to rectify the underpayments.”

Asked why it had taken two years, she cited a reorganization at UnitedHealthcare and a change in the insurer’s representative assigned to the case.

But UnitedHealthcare contested that view. “This was paid accurately,” said Caroline Landree, a spokesperson for the insurer.

But those explanations don’t satisfy Kruzic, a geological consultant: “Receiving a bill two years after the service wouldn’t fly in any other industry. We could never contact a client two years after we completed a project and say, ‘By the way, we missed this charge.’”

“How could this be considered anything but surprise billing?” he added.

The federal No Surprises Act doesn’t protect against all types of medical bills that patients find surprising. It primarily protects patients from out-of-network charges when they visit an in-network hospital, or in an emergency.

But in medical billing, what’s legal and what’s reasonable are two very different issues.

“The bill certainly sounds outrageous,” said Maxwell Mehlmen, co-director of the Law-Medicine Center at the Case Western Reserve University School of Law. “The question is whether it’s legal.”

That, he said, “is a matter of state law and the terms of the insurance policy and the agreement between the hospital and the insurer.”

In Colorado, there are extensive regulations about how long health care providers have to file a claim and . For instance, claims for Medicaid patients must be filed from the date of service. For patients with private insurance, the terms may be outlined in their insurers’ contracts with individual providers.

If a hospital and the provider and insurer were working out payment in good faith, then a patient can be billed for their share of the costs years later.

The Resolution

Within hours of ���ϳԹ��� News contacting the hospital’s media relations department for this article, Kruzic got a call from a hospital executive telling him his bill had been adjusted to zero.

Blaming administrative changes at the insurer, Radford Foster of CommonSpirit said that UnitedHealthcare had taken so long to properly pay the bill that the hospital couldn’t collect from the patient. She said that Kruzic’s statement balance “was to be adjusted to zero, but due to a clerical error, a statement was sent to the patient in error.”

UnitedHealthcare’s Landree said that “given the significant delay, we are addressing this issue directly with the physician’s office.”

“Mr. Kruzic will not be responsible for any additional costs related to this bill,” she said.

The Takeaway

���ϳԹ��� News’ “Bill of the Month” series receives complaints every year about ghost bills — bills that arrive long after a service is rendered.

Sometimes it’s because the insurer and hospital are haggling over payment, and the patient’s responsibility — usually a percentage of that number — can’t be calculated until the dispute is resolved. Other times, insurers audit old bills and, determining they overpaid, try to claw back the money, resulting in the patient (or even the patient’s surviving spouse) being billed for the difference.

For now, the legality of billing long after treatment depends primarily on the fine print of insurance contracts.

An insurer’s word that a claim has been “processed” doesn’t mean that the insurer has agreed to pay and that the billing is resolved. It could also mean that the insurer balked at the bill or completely denied payment.

As for Kruzic and his affinity for hot peppers? He said he still loves spicy food, but in his cooking, “I will not use scorpion peppers again.”

Bill of the Month is a crowdsourced investigation by ���ϳԹ��� News and that dissects and explains medical bills.��Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it!

���ϳԹ��� 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 .

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La inquilina guatemalteca de su amiga, quien no sabía que estaba embarazada, acababa de dar a luz a un bebé prematuro en una casa en Nueva Orleans. Los padres no tenían residencia legal, y la madre se negó a ir al hospital por miedo a ser detenida por agentes de inmigración federales.

“Hay sangre por todos lados, y el bebé está muerto”, recuerda Rosales-Fajardo que le dijo su amiga.

Rosales-Fajardo se puso las sandalias, agarró guantes quirúrgicos y corrió hacia la casa.

Inmigrante de Brasil, Rosales-Fajardo es organizadora comunitaria en Nueva Orleans Este, que concentra una gran comunidad inmigrante. No tiene formación médica formal, pero tiene experiencia asistiendo partos.

Al llegar, observó la habitación. Un niño de 3 años estaba de pie a un lado mientras la madre se sentaba al borde de la cama. El padre sostenía a su hijo recién nacido envuelto en toallas empapadas de sangre; el bebé no respiraba.

“El bebé estaba completamente gris”, dijo después Rosales-Fajardo.

Le limpió la boca y le frotó la espalda antes de hacerle pequeñas compresiones en el pecho y darle respiración boca a boca.

Le dijo a los padres que debía llamar al 911 para que la madre y el bebé recibieran atención en un hospital. El bebé ya había nacido, pero el parto aún no había terminado.

“Le aseguré que iba a estar a salvo, se lo prometí”, dijo Rosales-Fajardo.

El miedo se sentía en la habitación. Aun así, hizo la llamada y continuó con la reanimación. Finalmente, el bebé reaccionó y se movió en brazos de Rosales-Fajardo. Cuando llegó la ambulancia, la madre intentó evitar que su esposo la acompañara, aterrada de que arrestaran a ambos. Él fue de todos modos.

Poniendo la seguridad sobre la salud

“Estas son personas trabajadoras”, dijo Rosales-Fajardo. “Todo lo que hacen es trabajar para mantener a su familia. Pero estuvieron a punto de perder a su hijo por no llamar al 911”.

A casi dos semanas de iniciada la operación del Departamento de Seguridad Nacional (DHS, por sus siglas en inglés) llamada Catahoula Crunch, que comenzó el 3 de diciembre, profesionales de salud y defensores comunitarios en Louisiana y Mississippi reportan un aumento inusual de pacientes inmigrantes que se han salteado citas médicas y muestran altos niveles de estrés.

Según , el DHS había arrestado a más de 250 personas hasta el 11 de diciembre. Aunque las autoridades federales aseguran que están enfocadas en detener a personas con antecedentes penales, la agencia (AP) informó que la mayoría de las 38 personas detenidas en los primeros dos días del operativo en Nueva Orleans no tenían historial criminal.

Desde que el presidente Donald Trump asumió el cargo en enero, las familias inmigrantes en todo el país son más proclives a evitar o posponer la atención médica, en parte por preocupaciones relacionadas con su estatus migratorio, según de KFF y The New York Times.

La encuesta reveló que casi 8 de cada 10 inmigrantes que probablemente estén viviendo en Estados Unidos sin autorización legal dijeron haber experimentado efectos negativos en su salud este año, desde ansiedad y problemas de sueño hasta el empeoramiento de afecciones como presión arterial alta o diabetes.

Las redadas migratorias federales en California, Illinois, Carolina del Norte y ahora en Louisiana y Mississippi agravan las dificultades que estas familias ya enfrentan, como el acceso limitado a servicios, barreras lingüísticas, falta de seguro médico y altos costos.

Esa renuencia a recibir atención, incluso en casos de emergencia, parece justificada en medio de las redadas.

Según la (ACLU, por sus siglas en inglés), los hospitales y centros de salud generalmente deben permitir el acceso de agentes federales a las áreas abiertas al público. En California, este año, agentes federales se han apostado ��en , se han presentado en clínicas comunitarias y han custodiado a personas detenidas en .

Incluso ir o volver de una cita médica implica un riesgo, ya que las detenciones durante controles de tránsito son una práctica común de los agentes de migración.

La enfermera Terry Mogilles, del University Medical Center (UMC), dijo que los inmigrantes suelen representar al menos la mitad de los pacientes en su clínica de traumatología ortopédica en Nueva Orleans, muchos con lesiones graves relacionadas con el trabajo en la construcción que requieren cirugía. Pero ahora, Mogilles dijo que muchos de esos pacientes no van a sus citas de seguimiento, a pesar del riesgo de infecciones.

“Llamamos y no logramos comunicarnos”, dijo Mogilles. “Es muy angustiante porque no sabemos qué les está pasando después de la operación”.

El miedo se extiende en el sur

Las autoridades federales informaron que la operación Catahoula Crunch también se lleva a cabo en el sur de Mississippi, aunque la mayoría de los arrestos iniciales ocurrieron en el área metropolitana de Nueva Orleans. Las familias inmigrantes en todo Mississippi se están preparando para lo que se avecina.

Michael Oropeza, director ejecutivo de la organización El Pueblo, que presta servicios a comunidades inmigrantes de bajos ingresos en Biloxi y Forest, dijo que han visto a familias postergar atención médica, cancelar chequeos infantiles y dejar de surtir recetas.

“No es que no valoren su salud; es que no se sienten seguros”, afirmó Oropeza. “Cuando los hospitales y clínicas dejan de ser un lugar seguro, se pierde la confianza que tomó años construir. Puede desaparecer de la noche a la mañana”.

María, una residente de Biloxi originaria de Honduras, contó en español que ella y sus dos hijos han perdido citas médicas rutinarias porque están “aterrados” de salir de casa ante el aumento de la presencia de agentes federales de migración. Su esposo, quien tiene autorización para trabajar en Estados Unidos, fue detenido durante dos meses este año.

Sus hijos son ciudadanos estadounidenses. Antes tenían cobertura de Medicaid, pero María decidió darlos de baja hace tres años por miedo a que el uso de beneficios públicos afectara las solicitudes de residencia de su familia. Ahora pagan la atención médica de sus hijos de su propio bolsillo.

Cuando se sientan seguros de volver a salir, María dijo que su prioridad será buscar atención en salud mental para abordar el estrés que ha vivido su familia.

“Yo necesito visitar un médico definitivamente para que me chequee porque no me siento bien”, dijo, al describir su ansiedad, depresión e insomnio.

En Louisiana, Marcela Hernández, de , una organización sin fines de lucro que brinda ayuda directa a inmigrantes, dijo que muchas de las familias con las que trabaja . Refugiarse en casa y perder días de trabajo solo aumenta el estrés. Hernández contó que recibió 800 llamadas pidiendo comida en solo dos días, de familias que tenían miedo de salir a la calle.

Según la agencia AP, la operación federal en Louisiana y Mississippi . Cuanto más se prolongue, más teme Hernández que comience a haber desalojos, ya que las personas no podrán pagar el alquiler, lo que traumatizaría aún más a una comunidad que a menudo ha tenido que emprender viajes peligrosos para llegar a Estados Unidos, huyendo de situaciones difíciles en sus países de origen.

“No abandonas tu país sabiendo que vas a ser violada en el camino solo porque quieres venir a conocer a Mickey Mouse”, dijo.

Rosales-Fajardo, quien dirige una organización sin fines de lucro llamada El Pueblo NOLA, comentó que muchas familias le cuentan que sus hijos han comenzado a hacerse pis encima por el miedo y el estrés.

A nivel nacional, inmigrantes en situación migratoria irregular han reportado que algunos de sus hijos tienen problemas para dormir o cambios en el rendimiento escolar o en su conducta, según la .

Grupos comunitarios esperan que personas de la comunidad se movilicen para llevar alimentos y productos de higiene a los hogares de inmigrantes, y que profesionales de salud ofrezcan más visitas domiciliarias o por telemedicina.

Como en otros hospitales, las salas de espera del UMC son consideradas espacios públicos, explicó Mogilles. Pero el sindicato de enfermeras pide que el hospital establezca áreas seguras a las que los agentes federales no tengan acceso y políticas claras para proteger al personal de salud que a su vez cuida a los pacientes.

Las citas postoperatorias no pueden realizarse de forma virtual, por lo que los pacientes necesitan sentirse lo suficientemente seguros para venir, explicó Mogilles.

El cuidado prenatal y postnatal también es difícil de ofrecer de forma virtual, lo que pone en riesgo la salud de embarazadas o mujeres que han parido recientemente, explicó Latona Giwa, directora ejecutiva de Repro TLC, una organización nacional de capacitación en salud sexual y reproductiva.

Desde que en septiembre, Giwa dijo que las clínicas y proveedores con los que trabaja reportaron que el 30% de sus pacientes no habían ido a sus citas médicas. Las farmacias reportaron una caída del 40% en la recolección de medicamentos.

“Sabemos que en el manejo de afecciones crónicas, especialmente durante el embarazo, pero también en general, incluso faltar a una sola cita puede afectar el desarrollo de la afección y empeorar los resultados del paciente”, dijo Giwa.

En Louisiana, donde los resultados de salud materna , el temor al arresto podría agravar una crisis que ya se intensificó con la anulación de Roe v. Wade y poner vidas en riesgo. Giwa está especialmente preocupada por las familias con bebés prematuros en la unidad de cuidados intensivos neonatales (NICU, por sus siglas en inglés).

“Imagínate que tu bebé está en el hospital, tan vulnerable, y tú tienes miedo de ir a verlo y cuidarlo porque temes ser deportada”, dijo, señalando que la salud de un recién nacido depende en parte de la presencia de sus padres.

Esa es la situación que enfrenta la familia guatemalteca en Nueva Orleans.

En un día reciente de diciembre, Rosales-Fajardo actuó como traductora y defensora de la familia durante su primera visita para ver a su hijo en la NICU, en un hospital en la zona norte del lago Pontchartrain. El personal les dijo a los padres que necesitarían hacer ese viaje largo y riesgoso varias veces durante al menos un mes, para brindar contacto piel con piel y leche materna.

Rosales-Fajardo condujo a los padres, quienes tenían miedo de cruzar el puente por su cuenta por temor a ser detenidos. Dijo que seguirá llevándolos las veces que sea necesario.

“Cuando ven a alguien hispano manejando o algo así, ya les parece sospechoso”, dijo sobre los agentes federales.

Pero el bebé está a salvo y saludable. Y los padres nombraron a Rosales-Fajardo como su madrina.

Gwen Dilworth de Mississippi Today y Christiana Botic de Verite News colaboraron con este artículo.

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The friend’s Guatemalan tenant, who didn’t know she was pregnant, had just delivered a premature baby in the New Orleans house. The parents lacked legal residency, and the mother refused to go to a hospital for fear of being detained by federal immigration officers.

“There’s blood everywhere, and the baby’s dead,” Rosales-Fajardo recalled her friend saying.

Rosales-Fajardo put on her sandals, grabbed surgical gloves, and rushed to the house.

Rosales-Fajardo, herself an immigrant from Brazil, is a grassroots organizer and advocate in the New Orleans East community, where many immigrants live. She has no formal medical training, but she has experience with delivering babies.

She scanned the room when she arrived. A 3-year-old child stood to one side while the mother sat on the edge of the bed. The father held their swaddled newborn son, who wasn’t breathing and was wrapped in blood-soaked towels.

“The baby was completely gray,” Rosales-Fajardo later said.

Rosales-Fajardo wiped fluid away from his small mouth and rubbed his back before performing tiny chest compressions and breathing air into his lungs.

She told the parents she had to call 911 to get the mother and newborn to a hospital for care. The baby was out, but the delivery wasn’t over.

“I assured her. I promised her that she was going to be safe,” Rosales-Fajardo said.

Fear hung over the room. Still, she made the call and continued performing CPR. Finally, the newborn revived and squirmed in Rosales-Fajardo’s arms. When the ambulance arrived, the mother tried to keep her husband from riding with her, terrified they would both be arrested. He went, anyway.

“These are hard-working people,” Rosales-Fajardo said. “All they do is work to provide for their family. But they were almost at risk of losing their child rather than call 911.”

Putting Safety Over Health

Nearly two weeks into the Department of Homeland Security’s Operation Catahoula Crunch, which launched Dec. 3, health professionals and community advocates in Louisiana and Mississippi report that a significantly higher-than-usual number of immigrant patients have skipped health care appointments and experienced heightened stress levels.

According to a , DHS said it had arrested more than 250 people as of Dec. 11. Though federal officials say they’re targeting criminals, that most of the 38 people arrested in the first two days of the New Orleans operation had no criminal record.

Since President Donald Trump took office in January, immigrant families nationwide have become more likely to skip or delay health care, due in part to concerns about their legal status, according to a by KFF and The New York Times.

The survey found that nearly 8 in 10 immigrants likely to be living in the U.S. without legal permission say they’ve experienced negative health impacts this year, from increased anxiety to sleeping problems to worsened health conditions such as high blood pressure or diabetes. The federal immigration raids in California, Illinois, North Carolina, and now Louisiana and Mississippi add to the health care barriers that these families already face, including access to services, language barriers, lack of insurance, and high costs.

That hesitancy to receive even emergency care appears justified amid the ongoing raids. Hospitals and health facilities generally must allow federal agents in areas where the public is allowed, . In California this year, federal agents have staked out , shown up at community clinics, and guarded detainees in . Even driving to and from appointments poses a risk, as traffic stops are a popular place for immigration agents to make arrests.

University Medical Center nurse Terry Mogilles said that immigrants typically make up at least half the patients in her orthopedic trauma clinic in New Orleans, many of them with construction-related, bone-crushing injuries that require surgery. But now, Mogilles said, many of those patients aren’t coming in for follow-up appointments, despite the risk of infection.

“When we call, we can’t get through,” Mogilles said. “It is so upsetting because we have no idea what’s happening to them post-op.”

A Chill Spreads in the South

Federal officials said the Catahoula Crunch operation extends to southern Mississippi, though the bulk of the initial arrests have occurred in the Greater New Orleans area. Immigrant families throughout Mississippi are hunkering down in anticipation.

Michael Oropeza, executive director of El Pueblo, a nonprofit serving low-income immigrant communities in Biloxi and Forest, said the organization has witnessed families delay care, cancel children’s checkups, and go without refilling medication.

“It’s not because they don’t value their health; it’s because they don’t feel safe,” Oropeza said. “When hospitals and clinics are no longer that safe place, people withdraw trust that took years to build up. It can disappear overnight.”

Maria, a Biloxi resident from Honduras, said, in Spanish, she and her two children have missed routine doctors’ appointments because they are “terrified” to leave the house amid an increased presence of federal immigration officers. Her husband, who is authorized to work in the U.S., was detained for two months this year.

Her children are U.S. citizens. They previously qualified for Medicaid, but Maria opted to disenroll them three years ago out of concern that using public benefits would jeopardize her family’s residency applications, she said. The family now pays for their children’s care out-of-pocket.

When it feels safe to attend doctors’ appointments again, Maria said, her priority will be seeking mental health care to address the stress her family has endured.

“I definitely need to see a doctor to get checked out, because I don’t feel well,” she said, describing her anxiety, depression, and insomnia.

In Louisiana, Marcela Hernandez of , a nonprofit that provides direct aid to immigrants, said many of the families she works with live . Sheltering at home and missing work only adds to the stress. Hernandez said she received 800 calls for food in two days from families afraid to leave home.

The federal operation in Louisiana and Mississippi , according to the AP. The longer it goes on, Hernandez said, the more she worries evictions will come next as people can’t pay rent, further traumatizing a community whose members often had to make difficult and dangerous journeys to flee hardships in their countries of origin to reach the U.S.

“You don’t leave your country knowing that you’re gonna get raped on the way just simply because you wanna come and meet Mickey Mouse,” she said.

Rosales-Fajardo, who runs a nonprofit called El Pueblo NOLA, said families tell her how children have started urinating on themselves due to stress and fear. Nationally, immigrants who are likely to lack legal status report that some of their children have had problems sleeping and that they’ve seen changes in school performance or behavior, according to the KFF and New York Times survey.

Community groups said they hope people step up locally to deliver food and hygiene products to immigrant homes, and that health care professionals provide more at-home or telehealth visits.

Like at other hospitals, UMC’s waiting rooms are considered public spaces, Mogilles noted. But the nurses union is calling for the hospital to create safe spaces for patients that federal agents can’t access and clearer policies to protect health care workers who shield patients. Post-op appointments can’t be done virtually, so patients need to feel safe enough to come in, Mogilles said.

Prenatal and postnatal care is also challenging to provide virtually, leaving the health of new and expecting mothers vulnerable, said Latona Giwa, executive director of Repro TLC, a national sexual and reproductive health training nonprofit.

Since the in September, Giwa said, the clinics and health providers her organization works with have reported that 30% of patients had missed appointments. She said pharmacies saw a 40% drop in medication pickups.

“What we know about management of chronic conditions, especially in pregnancy, but in general, is that even missing one appointment can impact the trajectory of that condition and worsen a patient’s outcomes,” Giwa said.

In Louisiana, which already has , the fear of arrest could exacerbate the crisis worsened by the overturning of Roe v. Wade and threaten lives. She’s especially concerned about families with preterm babies in the neonatal intensive care unit, or NICU.

“Imagine your child is in the hospital, and so vulnerable, and you are terrified to go visit and care for your newborn infant because you’re worried about being deported,” Giwa said, noting that a newborn’s health partly relies on parental visits.

That’s the position the Guatemalan family in New Orleans is navigating.

On a recent day in December, Rosales-Fajardo acted as the family’s translator and advocate on their first visit to see their son in the NICU at a hospital on Lake Pontchartrain’s Northshore. Hospital staffers told the parents they would need to make the long and risky trip to the hospital repeatedly for at least a month to provide skin-to-skin contact and breast milk.

Rosales-Fajardo drove the parents, who were afraid to travel alone out of fear of being pulled over and arrested on a bridge. She said she’ll keep driving them as long as she needs to.

“Whenever they see a Hispanic driving or anything like that, that’s suspicious to them,” she said of federal agents.

But the baby is safe and healthy. And the parents have named Rosales-Fajardo his godmother.

Gwen Dilworth of Mississippi Today and Christiana Botic of Verite News contributed to this report.

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