A Trauma Team’s Nightmare: Six Border Wall-Fall Patients in Six Hours

Eighteen miles north of the San Diego border with Mexico, doctors with the Scripps Mercy trauma service looked at the clock. When it struck midnight on September 1, it would again be their turn to receive migrants who fell off the border wall while trying to climb over into the U.S.

Within the next 6 hours, the 400-bed Hillcrest hospital would be busy.

In an email message at 6:45 a.m. today, Chris Van Gorder, the CEO of Scripps Health, e-mailed MedPage Today with alarming news. Mercy’s level 1 trauma surgeons were, at that moment, grappling with multiple injuries sustained by six migrants who suffered border wall-fall injuries.

Six severely injured migrants in six hours.

“Already six falls transported to Mercy trauma — 1 in bad shape,” he wrote, implying that he expected more.

It Gets Like This

Every other month, when Mercy is on call for these injuries, it gets like this — but not usually so many in one day.

Since the border wall height was raised in 2019 — from around 18 feet to 30 feet — migrants are falling from higher heights, hitting rocks or hard dirt. They’re incurring brain injuries that are worse, shattering femurs and feet and ankles and pelvises in much more painful and complicated ways.

There are debilitating facial injuries, wounds to the chest and abdomen, often requiring specialty care that may be needed elsewhere at the same time. Before the wall was raised, surgeons saved these patients. Now, the discharge is often to the morgue.

Increasing numbers of border wall-fall patients are challenging trauma teams at both Scripps Mercy and UC San Diego (UCSD), which share trauma call on alternate months. Just from Jan. 1 to July 31, Mercy reported treating 141 patients and UCSD reported 159, putting them on track to beat prior years’ wall-fall counts.

UCSD also takes trauma patients who fall off the wall in the rocky desert areas east of San Diego in Imperial County and has also reported challenges in treating and housing all of these patients, many of whom have no source of payment.

One weekend last October, UCSD received nine patients overnight.

The data collected by both hospitals for an academic presentation in January show an increasingly tragic human toll: Injury severity scores are higher. Lengths of stays are longer. Number of surgeries required by many of the patients are much greater. The length of time the surgeries take is longer, often delaying other surgeries competing for operating room time.

Hospital sources explained that one reason border wall fall patients come in clusters is because they are traveling with coyotes. The ladder may break, or one person may fall, sending others below toppling to the ground as well.

That puts a strain on the ambulance system, with paramedics being pulled away from domestic injuries to handle multiple traumas along the border, a 20- to 30-minute drive, or much longer if the fall is in a remote part of the border.

Taxpayers Pay

This is especially concerning for Van Gorder. In an e-mail earlier this week, he gave MedPage Today three examples of how — beyond the human tragedy and pain these patients suffer and the toll on the hospital’s teams — these patients are expensive for taxpayers.

Those examples were:

• 10/9/21: Three-day stay. Jumped 20 feet, ankle/hip. U.S. Customs and Border Protection brought to Scripps. Charges of $95,985.98. The Division of Immigration Health Services Law Enforcement paid $8,882.30. The remainder written off.

• 1/21/22: Three-day stay. Jumped, found non-ambulatory. Border Patrol brought to Scripps. Charges of $110,793.86. DIHS Law Enforcement paid $38,910.27. The remainder written off.

• Late July: Seven-day stay. Jumped. Paramedic brought to Scripps. Homeless, transiting to New York. Charges of $483,900.65. No pay / not Medi-Cal eligible.

In California, Medicaid, which is called Medi-Cal, pays some of the bill at one third of the cost. Federal tax coffers pay negotiated amounts as well when patients are in border patrol agent custody, standing on guard by the patient’s bedside. Often, sources told MedPage Today, they “discharge” the patient from custody and thereby get out of paying the bill.