Bureaucratic paperwork is delaying medical flights from Haiti to the United States and is endangering children wounded in the earthquake, doctors say.
Port-au-Prince – One child died and the condition of critically ill children from Haiti’s earthquake worsened amid stricter rules over medical flights to Miami hospitals and others in the United States, doctors and patients say.
While they await permission to fly her out, doctors manually pumped oxygen for day-old Guirland Fleurant, born at the University of Miami airport field hospital by cesarean section Thursday night. Until she was transferred to a Haiti hospital with an incubator late Friday, she was being kept warm with instant military meals.
Whitney Constant, 15, got gangrene three days after being told she would be heading to Miami for medical care. On Friday, she lost the lower half of one leg and the foot on the other. Another 14-year-old, whose name frenzied doctors can’t recall, died on Tuesday.
“They want paperwork. We don’t have paperwork,” said Miami Children’s Hospital Dr. William Muinos, who is running the pediatric unit of the field hospital built in Port-au-Prince to treat quake victims. “They don’t have passports. They don’t have IDs. They don’t have homes. They don’t have anything.”
The issue of transporting patients from quake-ravaged Haiti exploded last week, when medical flights were temporarily suspended after Gov. Charlie Crist sent a letter to U.S. officials questioning who would pay for mounting bills at Florida hospitals. The Obama administration ultimately agreed to pay for the children’s care.
But doctors in Haiti say that the new U.S. Department of Health and Human Services criteria for transporting Haitian quake victims is so strict that hardly anybody qualifies. A person would have to be facing imminent death within 48 hours from injuries directly relating to the 7.0-magnitude quake that killed up to 200,000 people.
A spokeswoman from the U.S. Department of Health and Human Services said a medical review board that includes U.S. doctors, the Haitian government and other agencies considers patients on a case-by-case basis. She said doctors must decide if a condition is life-threatening and whether a patient can survive a flight.
“Every case is different,” said Jenny Backus, the Health and Human Services spokeswoman. “We want to take people who can survive the flight and get help on the other side.”
Complicated
Getting permission for the children to leave has become more complicated since Sunday’s arrest of 10 Americans who were caught trying to cross the border to the Dominican Republic with children they said they believed were orphans. They were charged Thursday with kidnapping.
“Now, no pilot will take these patients without papers,” said Dr. Shayan Vyas of Miami Children’s Hospital. “I can get a plane down here tonight. It’s the paperwork. You can’t just sneak kids into the country.”
Vyas said he arrived in Miami last week with child patients and faced an onslaught of questions from the Border Patrol. He said questions included: Where are the papers? Who are this child’s parents? How do you know these people who say they are the child’s parents are who they say they are?
Anticipating problems, Vyas typed up a birth certificate for baby Guirland — on the hospital computer.
“Last week I told them, ‘You can ask me questions later,’ ” he said. “Now you cannot find a pilot or an airport who will take them.”
Puzzled parents keep asking when their children will leave the country.
“We don’t know what the holdup is. Our daughter is only getting worse here,” said Josilin Constant, whose daughter Whitney had a double amputation days after being told she’d get to leave for Florida.
She was trapped in the rubble of her home for five days. Her 11-year-old brother and 23-year-old aunt died.
Although her two legs were broken and wounded, she could move.
“She did not look that bad,” Constant said. “Then she got a fever. They didn’t realize until today that it was coming from her leg.”
On Tuesday, Constant said, doctors told her she was approved for a medical flight. On Friday, she lost her leg and foot.
“I did not ask for her to go to the United States,” her father said. “The doctor decided it.”
The child that died of a pulmonary embolism Tuesday would have survived had she been evacuated, he said.
“She was told she would leave,” Dr. Muinos said. “Within 24 hours, that promise was denied.”
The Paperwork
Site director Elizabeth Greig acknowledged that although efforts to fly baby Guirland out of Haiti are moving fast, paperwork for other children has not been submitted. They did not qualify for military flights, she said, and there is no way to get paperwork for the others.
“The Department of Health and Human Services lifted the embargo on flights but made the criteria so strict that you can’t get anybody in,” Greig said. “There just aren’t injuries like that anymore.”
Since the flights resumed, Greig said she has moved just nine patients — six of whom were backlogged from during the five-day suspension.
Waiting
Joanna Benedict Pierre Louis is still waiting to leave. The quake ripped the skin, muscles and tendons off her leg. She has to be completely sedated every time her dressing is changed.
“We were told that our child has to be in the United States because her wounds are so deep,” said her mother, Evelyn Antoine. “Everything seemed to be ready. At the last minute, the government said no.”
Her father Sony Pierre Louis said some parents are ready to take their kids home.
“From the moment we got here, they said she would leave the next day,” he said. “I just do not think my child is going to make it here. She is not getting proper care.”
Dr. Muinos looked at Joanna’s gaping wound and her hand-scrawled chart.
“These are not optimal conditions,” he said. “This is a dirty, grassy hospital. It is not the Johns Hopkins ICU.”
Miami Herald staff writer Trenton Daniel contributed to this report.
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