Jennifer Smith Richards, Annie Sweeney and Jason MeisnerContact ReportersChicago Tribune
The charges started racking up the moment Annette Johnson arrived at Mount Sinai Hospital with a gunshot wound to her left forearm.
Doctors sliced open Johnson's arm and installed a $500 metal plate to shore up her shattered ulna, securing it with numerous bone screws that cost $246 apiece. There were morphine drips to quell pain, tetanus shots to prevent infection, blood screens and anesthesia.
Two years earlier in a different part of the city, Leo Leyva arrived at a North Side hospital with a gunshot wound to his back. His last memory before going under anesthesia was a nurse telling him they were going to take good care of him and to count up to 10.
As the 18-year-old drifted off, the emergency room team at Advocate Illinois Masonic Medical Center went to work to save his life, starting IV lines and X-raying his chest and abdomen before performing an emergency surgery to remove the bullet and repair the damage.
For both Johnson and Leyva, just two of the thousands of gunshot victims in Chicago every year, the first hours and days of their hospital treatment were only the start of what would be costly recoveries that continue to this day.
Still, the bills for their initial treatment were staggering. In his first 35 minutes at the hospital, Leyva had racked up $21,521 in charges, and by the time he was released three weeks later the bill totaled more than $157,000. For Johnson, who spent barely 24 hours at Mount Sinai, the hospital charges approached $27,000.
An unprecedented analysis of state data by the Tribune reveals that the initial medical costs for treating Chicago gunshot victims like Johnson and Leyva add up to tens of millions of dollars each year. And those costs are rising.
The data — obtained by the Tribune after months of negotiation with public officials — show that Chicago-area hospitals billed more than $447 million to treat some 12,000 documented victims of gun violence in the city between 2009 and mid-2016.
And even that figure represents just a fraction of the total billed. While the hospitals charge for room and board as well as equipment and drugs, the surgeons, anesthesiologists and other medical professionals who treat gunshot victims in emergency rooms across the city typically bill separately.
The data show that the victims who bear the physical and emotional scars of being shot live mostly in economically depressed and racially segregated neighborhoods. But the financial burden of caring for survivors of gunshot wounds extends well beyond neighborhood boundaries, according to the Tribune analysis.
In fact, patients who live in poverty and are insured through the publicly funded Medicaid and Medicare programs account for nearly half of the costs analyzed by the Tribune.
Dr. Amir Vafa, chief of trauma surgery and critical care at Mount Sinai, said the violence has ripple effects that touch on every aspect of the city in some way regardless of where it happens.
"It is not a 'me' or a 'you.' It's an 'us,'" Vafa said in an interview at the hospital, which serves largely black and Hispanic neighborhoods on the city's West Side. "We are all in this together. The reality is the entire fabric of society is connected, right? Nobody lives in an absolute bubble."
The numbers obtained by the Tribune do not reflect what ongoing treatment might cost patients and taxpayers once a patient is discharged, whether it's follow-up care, physical therapy or mental health treatment to address the trauma of being shot.
To highlight the financial and emotional hurdles that many shooting survivors face, Johnson and Leyva each agreed to provide their detailed medical and billing records to the Tribune.
Eight years after he was wounded, Leyva remains partially paralyzed, using a wheelchair or braces to get around, but his recovery has been remarkable in many ways.
Johnson, though, continues to struggle both physically and mentally. She's faced not only a painful recovery after surgery but also the tragic loss of her 15-year-old son, Antonio, an honor student and budding football star who was fatally shot in the same gang-related attack that left her wounded.
"This shooting, it has parted my whole family," Johnson said in an interview. "It shattered my life, physically, emotionally. It shattered my son's life. ... All he wanted to do was go to school and play football."
Putting an accurate price tag on what it costs to treat all victims of gun violence in Chicago is nearly impossible. Hospitals aren't required to note whether they've treated victims of firearm assaults, and the powerful gun lobby has successfully stifled research on gun violence at the federal level. Privacy laws also limit the types of data that the government is willing to release.
The data released to the Tribune represent more than 11,800 patient visits involving gunshot victims in Chicago, only an estimated two-thirds of the known shooting victims during the 7 1/2-year time frame studied.
The figures also don't reflect the amount ultimately paid by patients or taxpayers — a fraction of what the hospitals billed. Private insurance companies negotiate payments based on treatment, and patients who pay out-of-pocket or have no insurance also can negotiate. Medicaid and Medicare pay using a set fee schedule for procedures and hospital stays.
All together, the Tribune conservatively estimated that hospitals typically get paid about 30 percent of what they bill.
The data indicate that charges from area hospitals rose significantly over the 7 1/2-year span.
Hospital charges in 2009 for patients admitted in Chicago totaled $41.6 million. In 2015, the last complete year of data, hospital charges added up to a combined $62 million. Many categories of charges contributed to that increase, including charges for operating rooms and anesthesiology, both of which more than doubled.
Back in 2009, gunshot inpatients in Chicago averaged about $57,963 in charges for their hospital stay. Through the first half of last year, inpatients racked up $93,647 on average in hospital charges.
Illinois' hospital charging data also indicate that inpatient stays grew longer, most likely a factor in the escalating charges.
For each year since 2009, the average length of stay in a Chicago hospital for victims of a firearm assault hovered at about a week. For similar inpatients treated in the first half of 2016, the length of stay grew to more than nine days on average.
The breakdown in the types of insurance used by hospital inpatients makes clear that the financial burden of the medical costs associated with gun violence often falls on taxpayers, not the victims.
Nearly half of the amount for treating inpatients after a firearm assault was billed to taxpayer-funded Medicaid and, less often, Medicare. Less than one-quarter of inpatients were insured through commercial insurance or HMOs, and others either were self-pay or insured in some other way.
The data are further confirmation of how skewed gun violence is along racial and socio-economic lines. Nearly two-thirds of the hospital inpatients treated for injuries suffered as a result of firearm assault were black males ages 15 to 44, the data showed.
The costs to treat gunshot wounds are driven by the unique and critical nature of the injuries. The data paint a picture — in unadorned medical terms — of the bodily destruction: patients with injuries to the head and neck, abdomen, hips and thighs; bullets that caused open complex fractures of bones, left small intestines exposed and lacerated livers.
Doctors can't afford to take a wait-and-see approach.
"With a penetrating injury, especially a gunshot wound, the patient is so sick they immediately need to operate," said Dr. Vafa of Mount Sinai.
When alerted that a gunshot victim is en route, Mount Sinai goes into high-alert. Some 15 medical personnel are mobilized. Various tests and procedures, among them X-rays and CT scans, are ordered to determine the seriousness of the wound. Blood is readied in case a patient's blood pressure suddenly drops. Stapling devices need to be delivered to the operating room.
"The hospital needs to be in a constant state of being ready," Vafa said. "That includes people giving X-rays, people drawing blood, laboratory work, operating rooms ready to go, doctors ready to go."
How charges add up
The first shot fired at Annette Johnson should have killed her.
It was a warm September afternoon six years ago. The then-37-year-old mother of three was standing on her front stoop in Chicago's Garfield Park neighborhood unloading groceries with her youngest son, Antonio. They were talking about a new pair of pants he wanted for the upcoming homecoming dance when a car pulled up and she saw the barrel of a gun pointed out the window.
Johnson froze. She remembered wondering if that gun was really pointed in their direction. She heard the gunman yell something at her older son, Anthony Jr., who had come out of the house to help with the groceries. Then came the crack-crack-crack of the shots. The left-handed Johnson instinctively threw her left arm in front of her face.