Family Medicine Doctors ‘Forgotten on the Front Lines’ of the Pandemic

When you think of frontline health care workers, doctors and nurses in hospitals might come to mind, but independent family doctors are in that category, too.



a sign on a brick building


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“Forgotten on the front lines is what we are,” said. Dr. Guy Culpepper, founder of Bent Tree Family Physicians.

Culpepper says the front lines of the pandemic aren’t in emergency rooms, they’re at his front door.

“When you talk about flattening the curve, that curve flattening happened in my office,” he said.

From the parking lot of his Frisco office, Culpepper says more than 7,000 people have been tested for COVID-19. Nearly 1,200 have tested positive.

“We’ve kept 1,100 of them away from hospitals and emergency rooms,” Culpepper said.

Culpepper says he has about 250 active COVID-19 patients. Those recovering from home are checked on by phone every day. “We get about 1,500 telephone calls a day,” he said.

His numbers tell a story. They also speak to his heart.

“Part of the passion I have in managing my COVID patients and managing all my patients is the feeling of I’m only here because of them,” Culpepper said, emotionally.

Like many independent doctors, Culpepper closed his doors in the spring and furloughed all 75 employees.

On the verge of going out of business, it was a GoFundMe page set up by patients that helped him get through.

“We’re only kept up by those handful who know us and appreciate us because we know all too well that most of the country doesn’t know the work we’re doing,” Culpepper said.

Culpepper, who’s been in family medicine for 33 years, says no federal programs exist to sustain private physicians, like him. Nationwide, he says his profession is in crisis because private practices, “can’t handle the economics of a pandemic.”

He says nearly 10% of primary care practices that temporarily closed this year have yet to reopen.

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On the front lines of COVID, nurses confront life and death

EL PASO, Texas (AP) — A fire engine wailed its siren up Cotton Avenue and disappeared behind the El Paso Long Term Acute Care hospital.

A man at the front desk held his hand up to a visitor: “Please wait outside. A COVID patient is being transferred.”

Upstairs on the third floor, in an office outside the COVID-19 wing, nurse Valerie Scott updated a co-worker on the patient being rushed by the fire department to an emergency room. She wore black scrubs and spoke from behind a black surgical mask.

The supplemental oxygen wasn’t helping. The man couldn’t breathe.


“I don’t think he is coming back,” she said, worried.

725 people have died of COVID-19 in El Paso since March 23 — the day the county reported the first death tied to the novel coronavirus, according to El Paso Times. Grandparents, parents, siblings and one teenager have died; retired people, working people and teachers have died. Nurses have died.

The bed belonging to the man who left Scott’s hospital in distress would be occupied again that evening. The waitlist for her 15 dedicated COVID-19 beds had swelled overnight from 22 to 32 patients.

Across the city, more than 1,000 people per day are testing positive and the city’s major hospitals are overrun with severely ill and dying El Pasoans. Hundreds of health care workers have flown into El Paso to pick up shifts from exhausted doctors and nurses and to staff tent hospitals erected in parking lots. The refrigerators of six morgue trailers hummed, keeping the bodies cold.

The El Paso Long Term Acute Care hospital, physician-owned and licensed for 33 beds, is pitching in as it can.

“They tried to talk to the family,” Scott told her co-worker, who manages the relationship with acute-care hospitals, about the COVID-19 patient transferred out. “Basically, at this point, it would be better to give him comfort measures… Here there was nothing more we could do.”

She had reason to worry: When doctors have ordered an emergency room transfer of a COVID-19 patient, it meant things had taken a turn for the worse and the patient rarely survived.

The co-worker cursed under her breath.

In the city outside, beyond the hospital’s pale pink stucco walls, El Pasoans went about their day, most in face masks but with few other precautions. People shopped at Target and Walmart and shopping centers. Bars-turned-restaurants kept dining rooms open to guests. A fight between city and county leaders and businesses over restrictions on daily life lumbered through the court system.

The relentless war against a deadly, invisible enemy was out of sight to all but those working its front lines.

The El Paso Long Term Acute Care hospital faces southeast, soaking up morning light, built as it was in 1925 for tuberculosis patients when sunlight was the only cure for another disease that eats away at the lungs and suffocates those who succumb to it.

The COVID-19 wing occupies half of the hospital’s third floor.

Inside, the narrow

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On the front lines of Europe’s surging 2nd COVID crisis: Reporter’s Notebook

I’ve just left the intensive care unit of a hospital in Liege, Belgium. It’s impossible to know of course, but this is quite possibly the epicenter of Europe’s new coronavirus crisis.



a person standing in front of a refrigerator: A health worker standing in an intensive care unit treats a patient suffering from the coronavirus disease, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.


© Yves Herman/Reuters
A health worker standing in an intensive care unit treats a patient suffering from the coronavirus disease, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.

The city of about 200,000 residents nestled in eastern Belgium is at around a 41% infection rate, and the hospital is at full capacity. Intensive care unit numbers have tripled in three weeks. Belgium, which had 100 to 200 cases per day throughout June and early July, is now marking north of 10,000. On Oct. 25, it set a daily record with 17,709.

We stood outside one room — which patients are now forced to share due to overcrowding — to hear the groans of an elderly man who was just admitted. As doctors and nurses attended to him another ambulance swept up outside the window with another case.

MORE: Europe struggling with 2nd surge of COVID-19 case, and it may be worse than the 1st

The doctor guiding us on a tour admitted a chilling fact: health workers here (including himself) are now treating patients knowing they themselves have COVID-19.



a group of people standing in a room: Health workers take care of patients suffering from the coronavirus disease in a recovery room of an operating theatre transformed for COVID-19 patients, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.


© Yves Herman/Reuters
Health workers take care of patients suffering from the coronavirus disease in a recovery room of an operating theatre transformed for COVID-19 patients, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.



a person taking a selfie in a room: A health worker looks on in a recovery room of an operating theatre transformed for patients suffering the coronavirus disease, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.


© Yves Herman/Reuters
A health worker looks on in a recovery room of an operating theatre transformed for patients suffering the coronavirus disease, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.

Gallery: These States Just Broke Grim COVID Records (ETNT Health)

It’s an ethical dilemma, but not a choice this doctor could make. He now tests negative, but he said if he and others like him do not continue working, the health system here would go under. The toll on health workers, already exhausted from the first wave, about to be exacerbated by the second.

Why is it so bad? COVID fatigue, he says. Belgium relaxed the measures that had kept the country safe and now are going to pay a price. Lots of testing, yes. But not so much tracing.

MORE: Further restrictions, curfews imposed in Europe as continent fights ‘second wave’ of coronavirus cases

But they have learned some important lessons from the first wave.



A health worker picks up utensils in a recovery room of an operating theatre transformed for patients suffering the coronavirus disease, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.


© Yves Herman/Reuters
A health worker picks up utensils in a recovery room of an operating theatre transformed for patients suffering the coronavirus disease, at Montlegia CHC clinic in Liege, Belgium, Oct. 29, 2020.



a close up of a woman: A woman takes part in a demonstration at the hospital MontLegia, in Liege, gathering employees, and called by the Belgian trade union National Center of Employees, on Oct. 29, 2020 as the country faces a second wave of infections from COVID-19.


© John Thys/AFP via Getty Images
A woman takes part in a demonstration at the hospital MontLegia, in Liege, gathering employees, and called by the Belgian trade union National Center of Employees, on Oct. 29, 2020 as the country faces a second wave of infections from COVID-19.

We came across Florent, a 75-year-old man in the ICU who said

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Trump rule says health plans must disclose costs up front

WASHINGTON (AP) — Trying to pull back the veil on health care costs to encourage competition, the Trump administration on Thursday finalized a requirement for insurers to tell consumers up front the actual prices for common tests and procedures.

A major health insurance industry group said the regulation would have the opposite effect, raising premiums.

The late-innings policy play ahead of Election Day comes as President Donald Trump has been hammered on health care by Democratic challenger Joe Biden for the administration’s handling of the coronavirus pandemic and its unrelenting efforts to overturn “Obamacare,” the 2010 law providing coverage to more than 20 million people.

A related Trump administration price disclosure requirement applying to hospitals is facing a federal lawsuit from the industry, alleging coercion and interference with business practices.

The idea behind the new regulations on insurers is to empower patients to become better consumers of health care, thereby helping to drive down costs.


But the requirements would take effect gradually over a four-year period, and patients face a considerable learning curve to make cost-versus-quality decisions about procedures like knee replacements or hernia repairs. Add to that political uncertainty about the policy’s survival if Trump doesn’t get reelected, and the whole effort is running into skepticism.

Administration officials are adamant the changes will stand, arguing the goal of price transparency transcends political partisanship.

“It will be impossible to walk backwards on this,” Health and Human Services Secretary Alex Azar said. “How do you fight transparency on prices? How do you actually articulate the argument that you should conceal what something costs from the person trying to purchase it?”

Insurance companies contend that the rules will boomerang economically, by undercutting their ability to bargain with hospitals, drug companies, doctors and other industry players. Providers now accepting discounted rates will press to get paid more once they see what their upper-end competitors are getting.

“The final rule will work to reduce competition and push health care prices higher — not lower — for American families, patients, and taxpayers,” Matt Eyles, president of America’s Health Insurance Plans, said in a statement. “This is precisely the opposite of what Americans want in their health care.”

The new rules are being issued jointly by HHS, the Labor Department and the Treasury, which share jurisdiction over health insurance plans. They would:

— Starting in 2022, require insurers to make available data files on the costs of various procedures, allowing technology companies to design apps that let patients see costs not only under their own plan but other insurers’ plans as well.

— Starting in 2023, require insurers to make available to their policyholders cost-sharing details on 500 specific services, medical equipment and other items, as called for by the government.

— Starting in 2024, require insurers to make cost-sharing information available on all the services and goods they cover.

Patients would use an online shopping tool from their plan to see the negotiated rate between their doctor and the insurer, as well as an out-of-pocket

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Trump Rule Requires Health Plans to Disclose Costs up Front | Business News

By RICARDO ALONSO-ZALDIVAR, Associated Press

WASHINGTON (AP) — Trying to pull back the veil on health care costs to encourage competition, the Trump administration on Thursday finalized a requirement for insurers to tell consumers up front the actual prices for common tests and procedures.

The late-innings policy play comes just days ahead of Election Day as President Donald Trump has been hammered on health care by Democratic challenger Joe Biden for the administration’s handling of the coronavirus pandemic and its unrelenting efforts to overturn “Obamacare,” the 2010 law providing coverage to more than 20 million people.

A related Trump administration price disclosure requirement applying to hospitals is facing a federal lawsuit from the industry, alleging coercion and interference with business practices.

The idea behind the new regulations on insurers is to empower patients to become better consumers of health care, thereby helping to drive down costs.

But the requirements would take effect gradually over a four-year period, and patients face a considerable learning curve to make cost-versus-quality decisions about procedures like knee replacements or hernia repairs. Add to that political uncertainty about the policy’s survival if Trump doesn’t get reelected, and the whole effort is running into skepticism.

Administration officials are adamant the changes will stand, arguing the goal of price transparency transcends political partisanship.

“It will be impossible to walk backwards on this,” Health and Human Services Secretary Alex Azar said. “How do you fight transparency on prices? How do you actually articulate the argument that you should conceal what something costs from the person trying to purchase it?”

Insurance companies contend that the rules will boomerang economically, driving up costs. Hospitals and doctors now accepting discounted rates will press to get paid more once they see what their upper-end competitors are getting.

The new rules are being issued jointly by HHS, the Labor Department and the Treasury, which share jurisdiction over health insurance plans. They would:

— Starting in 2022, require insurers to make available data files on the costs of various procedures, allowing technology companies to design apps that let patients see costs not only under their own plan but other insurers’ plans as well.

— Starting in 2023, require insurers to make available to their policyholders cost-sharing details on 500 specific services, medical equipment and other items, as called for by the government.

— Starting in 2024, require insurers to make cost-sharing information available on all the services and goods they cover.

Patients would use an online shopping tool from their plan to see the negotiated rate between their doctor and the insurer, as well as an out-of-pocket cost estimate for procedures, drugs, durable medical equipment and any other item or service they may need.

The information would be available ahead of time, enabling an informed decision. Currently, most patients find out what they owe after they get back from the hospital and receive their “explanation of benefits” statement.

“We need to keep pricing on the front end, not the back end,” said Seema Verma, head

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‘Trench Warfare’ In Liege, Europe’s New Virus Front

Shell-shocked hospital staff, some of whom have tested positive for the coronavirus, are fighting a losing battle in the Belgian city of Liege against Europe’s second wave of Covid-19.

It is the second time that Belgium, a small EU country of 11.5 million people, has ended up as one of the hardest hit by the global pandemic. It has already seen more than 270,000 cases and 10,500 deaths.

And, according to the latest data, Brussels and Wallonia, the French-speaking region of which Liege is a major city, are now the epicentres of Europe’s renewed crisis.

Belgium is experiencing one of the worst second waves of the coronavirus pandemic in the world Belgium is experiencing one of the worst second waves of the coronavirus pandemic in the world Photo: AFP / Kenzo TRIBOUILLARD

This repeat performance brings a quiet rage to those on the front lines in the medieval city’s overwhelmed university hospital CHU Liege.

His hair unkept and eyes weary, Benoit Misset, head of the intensive care unit, weighs each word as he explains the daily onslaught from the silent virus threat.

Everyone fears that Liege will become the next Bergamo, the Italian city where scenes of overcome hospitals heralded a pandemic that was about to engulf Europe  Everyone fears that Liege will become the next Bergamo, the Italian city where scenes of overcome hospitals heralded a pandemic that was about to engulf Europe  Photo: AFP / Kenzo TRIBOUILLARD

“We’re losing. We’re overwhelmed. We’re bitter… because we’ve known this was coming for two months and the decisions weren’t taken in time,” he told AFP.

The hallway of his Covid unit is filled with staff and patients, and rooms are crowding even more quickly than in the first explosion of cases that ran from March until May.

“On Wednesday, we almost reached the number of cases we saw in the first wave,” says Christelle Meuris, an infection specialist and head of the unit.

“We’re afraid that the latest measures will not be enough to flatten the curve. We can see a tsunami coming,” said the doctor, whose unit now has 18 virus patients in its 26 beds.

Two days ago, Liege's university hospital began transferring patients to other Belgian provinces and to Germany  Two days ago, Liege’s university hospital began transferring patients to other Belgian provinces and to Germany  Photo: AFP / Kenzo TRIBOUILLARD

She said she fears that soon each room will have to take two patients, a complicated situation for a virus this contagious.

Everyone is worried that Liege, just a short drive from Germany or the Netherlands, will become the next Bergamo, the Italian city where scenes of overcome hospitals heralded a pandemic that was about to engulf Europe.

About 20 percent of current staff are unable to come to work About 20 percent of current staff are unable to come to work Photo: AFP / Kenzo TRIBOUILLARD

Before entering a patient’s room, Hendrika Abourou, a double-masked nurse’s aide, laces on three overblouses and squeezes her hands into two pairs of gloves, not forgetting her protective glasses.

“Each gesture is calculated. To move the patient, wash him, throw his sheet in a specific bag… We have to think all the time, pay attention to everything,” she explained.

Many of her colleagues did not make it beyond the first wave, giving up hospital work altogether. About 20 percent of current staff are unable to come to work.

“The shortage

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