https://www.npr.org/sections/health-shots/2023/03/15/1162588784/the-peoples-hospital-ricardo-nuila-treats-mostly-uninsured-undocumented

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'The People's Hospital' doctor treats Houston's uninsured and
undocumented : Shots - Health News Many of Ricardo Nuila's patients
at Houston's Ben Taub Hospital are dealing with serious illnesses as
a result of not being able to access basic preventive care. His new
book is The People's Hospital.
Shots - Health News

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Shots - Health News

This safety-net hospital doctor treats mostly uninsured and
undocumented patients

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March 15, 20231:06 PM ET
Heard on Fresh Air

Fresh Air

Terry Gross square 2017

Terry Gross

This safety-net hospital doctor treats mostly uninsured and
undocumented patients

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[gettyimage]
Enlarge this image

Paramedics at Ben Taub General Hospital speed a patient with a
gunshot wound to the trauma team for further care. Ben Taub is the
largest safety-net hospital in Houston. Gregory Smith/Corbis via
Getty Images hide caption

toggle caption
Gregory Smith/Corbis via Getty Images

Paramedics at Ben Taub General Hospital speed a patient with a
gunshot wound to the trauma team for further care. Ben Taub is the
largest safety-net hospital in Houston.

Gregory Smith/Corbis via Getty Images

As a doctor in a so-called "safety-net" hospital, Ricardo Nuila's
daily practice looks quite different from that of his colleagues who
work in private or not-for-profit hospitals. That's because
safety-net hospitals treat everyone who walks in the doors --
regardless of insurance status.

Many of Nuila's patients at Houston's Ben Taub Hospital are dealing
with serious illnesses as a result of not being able to get access to
basic preventive care. "What we see is that patients' lack of health
care has meant that the disease has been able to grow within their
bodies," he says. "Their cancer is widespread, or we find that they
have an infection that has not been treated or discovered."

In his new book, The People's Hospital, Nuila writes about his
experiences at Ben Taub, which is the largest safety-net hospital in
Houston. He says despite the hospital's budget constraints, the
doctors and nurses there still manage to provide quality health care.
By limiting the number of patients a practitioner can see in a day,
Ben Taub allows physicians to spend more time with their patients
than is typical.

"My cap is 15 patients in one day," Nuila says. "That's compared to
some of my colleagues in the private world, who I've heard admit up
to 24 patients in one night, or don't carry a cap."

Because resources are tight at Ben Taub, there is an emphasis on
using them mindfully, Nuila says. Instead of ordering an MRI with the
push of a button, for instance, he might talk to the radiologist
directly, to find out if extra imaging is really called for. "There
are benefits to further discussion between medical professionals
about emergencies and how to deal with these emergencies," he says.

Overall, Nuila says, working at a safety-net hospital allows him to
keep his focus on medicine: "I like that I have the time to be able
to hear my patients' stories, that I don't have to think about
billing all the time, that I can sit with them and hear about why
they came to the hospital and learn about their lives -- and that, no
matter what, we are going to be thinking about how best to help them,
regardless of whether they have insurance or not."

---------------------------------------------------------------------

Interview highlights

The People's Hospital, by Ricardo Nuila
Enlarge this image
Simon & Schuster
Simon & Schuster

On treating undocumented people at the hospital

It's not considered illegal. ... The law EMTALA -- the Emergency
Medical Treatment & Labor Act -- that was passed in the 1980s, that
states that anybody in the United States, whether you're a resident
or not, whether you have health insurance or not, can go to a
hospital and receive an exam and stabilizing treatment. So that's a
right that everybody in the United States has, regardless of
citizenship. What's different about the safety-net hospital is that
we have clinics and we have chronic care also -- and that was under
question by certain politicians, who ultimately found that it didn't
make any sense to question that. Because when you get in the way of
preventive care, when you get in the way of primary care, those
patients end up coming to the emergency room and they become much
more expensive. ... So, [the politicians] decided that the financial
gains were more important [than limiting care].

On explaining the American health care system to uninsured patients

California Is 1st State To Offer Health Benefits To Adult
Undocumented Immigrants

Politics

California Is 1st State To Offer Health Benefits To Adult
Undocumented Immigrants

The patients are all so different -- some have had multiple family
members in the United States before, so they understand the landscape
a little bit better. But yeah, it can feel very, very contradictory
when I tell patients that, well, "You need health insurance for
that." And they will say sometimes, "Well, in Mexico or in Guatemala
(or whatever), I don't necessarily." And it's hard to explain that in
the richest country in the world, there's little available for people
without health care insurance.

Now, I'm happy that in Harris County [in Texas], where I work at
Harris Health, we can provide a robust set of services. But somebody
who lives outside of the county doesn't have availability for those
services. And that's one of the things that I've argued, is that the
line between Mexico and the United States is not as important as the
line between Harris County and Fort Bend County, for instance, in
some of the treatments that we give to patients.

On speaking Spanish with patients

That's one of the reasons that I love my job and I love the hospital
where I work -- I can speak Spanish. ... The people are so happy to
hear somebody attempt to speak their language, and not just on a
translation basis, but the flavor of the language and also thinking
about the locations [they come from]. For instance, when I ask
somebody where they're from and they say Mexico or El Salvador, it's
never enough for me to hear just a country. I need to ask a region so
I can situate it in my mind, the map, and draw a relationship that I
have with that region. And so I think it helps a lot for building
trust with patients.

On his reaction when very sick patients put their faith in God

I don't dismiss it. Because I feel that science and medicine, we
don't know everything. There's a lot of mystery in this world and I
think faith is important. I'm not saying that faith in one particular
religion is important, but faithfulness is important. I think that in
my experience, when people demonstrate faith, whether it's in their
God or whether it's in the treatment, they do better. It's not my job
to take away that person's faith. What I tell people is that I'm just
doing my job, which is [that] I'm a human being, and I need to tell
you ... the recommendation from doctor human beings for this illness
and for the treatment, but that I'm just a person and I don't know.
And that's the truth - we don't know everything. We have very good
ideas. When somebody is close to death, we can prognosticate quite
accurately if that person's going to die or not. But I can not tell
exactly when that is going to happen. And I don't want to rob
somebody of their faithfulness.

On struggling with thoughts of suicide after the suicide of a friend
and colleague

Reach out and listen: How to help someone at risk of suicide

Shots - Health News

Reach out and listen: How to help someone at risk of suicide

I think everything was a struggle. And I think that seeing somebody
like Dave, who I admired so much, who was a friend, my best friend in
the hospital, who I could speak with and who was so knowledgeable and
intelligent -- just to know that that is a risk for me as I grow
older. Dave was also a very good father and it's something that I've
struggled with, parenting.

It felt so much like a pressure of trying to be a good father while
trying to be a good doctor, while trying to be a good writer. They
can work together, but there are moments where they feel like they
can just implode on themselves. And I think that knowing that that
had happened to my friend weighed on me and made me think, Is this
going to be me? Is this the fate that so many of us who care a lot
that we face? ...

Therapy helped. I found a therapist who was very attuned to people
who were creative types. ... That listening really helped. My
relationships improved. When I was at my lowest, I could look at my
relationships with the people who were around me, who I valued the
most, and I can see that at that moment they weren't great
relationships. And somehow over time, those relationships started to
improve and that helped immensely. I think that writing also helped
me too, at the end of the day.

On hospital staff losing their sense of meaning with their job
because of burnout

Health workers know what good care is. Pandemic burnout is getting in
the way

Shots - Health News

Health workers know what good care is. Pandemic burnout is getting in
the way

For me that just demonstrates a real fundamental problem with how
health care is administered in this country. If something like
medicine, where you are helping people on a daily basis, if you can't
see the meaning behind that, that's a bad omen. Whenever a patient
tells me, "I'm thirsty" and I go get them ice water, I feel really
good that day. Something as simple as that. With my Spanish-speaking
patients, they can say one phrase to me and I will feel satisfied for
that day -- when they say, "Que amable," which means you were very
kind in the way you said that. And I feel that that gives me a lot of
meaning for the day. But I feel that the pressures and the mechanism
by which health care operates right now obfuscates that for so many
people. And that's sad to me. Now, I take a little bit of heart in
that the medical field is really taking this seriously and is trying
to do something about this. There is an added emphasis now on
bringing in the arts and humanities into medicine.

    If you or someone you know may be considering suicide or is in
    crisis, call or text

    9 8 8 to reach the Suicide & Crisis Lifeline

    .

Audio interview produced and edited by: Sam Briger and Thea Chaloner.
Audio interview adapted for NPR.org by: Bridget Bentz, Molly
Seavy-Nesper and Deborah Franklin.

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