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Tennessee Man Sent Home From ER Twice Dies Of COVID-19

MARY LOUISE KELLY, HOST:

It was a COVID-19 death that shocked Nashville. Darius Settles was only 30 when he died on the 4 of July. He had been sent home from the emergency room twice. An investigation finds that uninsured COVID-19 patients are rarely told that hospital bills are covered. Blake Farmer of member station WPLN reports.

BLAKE FARMER, BYLINE: In their apartment, Darius Settles and his wife Angela both had been feeling ill with fevers and body aches. Then Darius took a turn.

(SOUNDBITE OF ARCHIVED RECORDING)

ANGELA SETTLES: My husband is having issues breathing, and he's weak.

FARMER: He asked his wife to call 911.

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A SETTLES: We're probably going to need paramedics over here to rush him to the hospital.

FARMER: He was stabilized and tested for COVID-19. The Nashville hospital sent him home with antibiotics and instructions to come back if things got worse. Three days later, they did, and his COVID test was positive. But Darius was between full-time jobs - playing the organ at a church as he launched a career as a clothing designer. He had no health insurance.

A SETTLES: He said, I bet this hospital bill is going to be high. And I said, babe, it's going to be OK. And we left it alone just like that.

FARMER: So he went back to the ER, where they tested his blood oxygen levels, which are usually a first sign that a COVID patient's in trouble. They had dropped but not dramatically. Next thing Angela knew, she needed to come pick him up again.

A SETTLES: And now you text me saying they're releasing to me? I have an issue with that.

FARMER: At first, she thought the hospital didn't want to admit a man who'd have trouble paying the big bill. But the hospital, owned by national chain HCA, treats hundreds of patients a year without insurance. And little did she know the federal government would have paid the bill through coronavirus relief funds. Most major health systems can be reimbursed for treating uninsured COVID-19 patients at a fairly generous rate. But NPR checked with major health systems, and patients aren't being told, at least not in the ER when they're making critical choices about their care. Even many doctors do not know enough about the reimbursement to explain it to uninsured patients. Plus, many doctors are reluctant to.

RYAN STANTON: The thing is I don't want to absolutely promise anything.

FARMER: Dr. Ryan Stanton is an ER doctor in Lexington, Ky., and represents the American College of Emergency Physicians. ERs have to at least stabilize everyone regardless of their ability to pay, and any hint of discouraging treatment can lose a hospital big money. Stanton also says he could never guarantee someone won't end up having to fight a bill.

STANTON: There should not be a false sense that it's going to be an absolute smooth path when we're dealing with government services and with the complexities of the health care system.

FARMER: For Darius Settles, he didn't attempt a third trip to the hospital. Instead of 911, he called his father - Pastor David Settles.

DAVID SETTLES: And he said, Dad, I need you to pray for me. I said well, son, of course I'm praying for you. He said, no, I really need you to pray for me. I want you to get the oil. I want you to come out here and lay hands on me and pray.

FARMER: He came and sat by his side. Angela fixed some peppermint, tea. But when they went to give Darius a sip, he was unconscious. He never revived. Pastor Settles was back in the pulpit just a few weeks later.

(SOUNDBITE OF ARCHIVED RECORDING)

D SETTLES: The Lord gives, and the Lord takes away.

FARMER: He shared his suffering and grief after the death of his son.

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D SETTLES: Whom I watched as the breath left his body.

FARMER: Darius left behind his own son, who is 6, and his widow, who can't shake a sense of personal guilt.

A SETTLES: Could I have done more? You know, and it's hard. And I know that he would not want me to feel that way.

FARMER: Angela Settles wonders, too, if the hospital could have done more for Darius. And even after failing to disclose its policy for uninsured COVID patients, it did send her a bill for part of her husband's care. Asked why, the hospital says it was sent in error and doesn't have to be paid.

For NPR News, I'm Blake Farmer in Nashville.

KELLY: And this story was produced in partnership with Nashville Public Radio and Kaiser Health News.

(SOUNDBITE OF LAMBERT'S "MANDAL") Transcript provided by NPR, Copyright NPR.