As COVID-19 crisis deepens, out-of-state patients seek help at Philadelphia hospitals

On Tuesday night, Simcha Shain loaded his 72-year-old father into his ambulance and began the 70-mile journey from Lakewood, N.J., to Philadelphia.

Rabbi Yudel Shain had fallen ill on Sunday, feeling weak and feverish. By Tuesday, he was struggling to breathe and could not walk. “Sim” Shain, 47, a paramedic with Lakewood’s Hatzolah — a volunteer emergency medical service primarily used by the town’s large Orthodox Jewish community — knew his father needed hospital care for what he suspected was COVID-19.

Shain said Hatzolah paramedics called six hospitals in the area. “All full,” he said. That’s when, he said, they called the Hospital of the University of Pennsylvania, an institution highly regarded by Lakewood’s Orthodox community. Hatzolah has sent several patients to Philadelphia hospitals since Sunday, as closer hospitals have become overwhelmed with coronavirus cases.

The family’s journey to Philadelphia is part of a trend that state and local authorities say will likely continue as cases surge in the coming weeks, outstripping capacity in parts of New York and New Jersey.

It’s legal for patients to seek care out of their area. Still, Shain said, nurses at HUP tried to discourage them from entering.

“They are screaming at us about why we are coming there, saying we have no right to come there,” he said. "I’m a paramedic bringing my father in an ambulance, and the charge nurse was screaming at us, saying the beds [are] only made for the people who live in the area. Can you imagine?”

HUP officials did not comment Friday on Shain’s account. In a statement on Thursday, when asked solely about treating patients from Lakewood, the hospital did not confirm the patients were there. Rather, a spokesperson said that “traveling significant distances and bypassing other hospitals to bring out-of-state patients to Philadelphia emergency departments ... could jeopardize the safety of the patient [and] also compromise our ability to care for our existing patients and the local community."

Patients who are very ill with the coronavirus infection can quickly take a turn for the worse, making long journeys dangerous, medical experts say. Still, city and state officials stress that hospitals are required to care for all patients who arrive seeking treatment.

“We are receiving patients from New York. We will continue receiving patients from New York,” said Philadelphia’s health commissioner, Thomas Farley, at a daily news briefing on the pandemic Friday. He added: “Some people, I think, want us to build a wall between New York City and Philadelphia, and we’re not going to do that. We may not like those New York City sports teams, but the people in New York deserve medical care as well.”

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New Jersey’s health system, too, is strained by coronavirus patients inundating emergency rooms and critical-care units across the state. In recent days, Gov. Phil Murphy has shown projections that indicate intensive care units will be at capacity by next Saturday. On Friday, at least five New Jersey hospitals signaled they could accept no more patients.

An executive from Lakewood’s Hatzolah said 11 patients had been transferred to HUP since Sunday. He believes “a high percentage of [them] were suspected coronavirus patients." The town has been walloped by the virus, with 438 residents testing positive.

Shain said he spoke with another Hatzolah paramedic who told him that a HUP staffer threatened to “pull his EMT license because he’s transferring a patient out of state," he said. He added that someone called him Friday and said Hatzolah shouldn’t be taking patients to HUP.

“I said, `No problem. Find us a hospital.' You think I want to drive an hour and 15 minutes with a patient?"

Patrick Norton, Penn Medicine’s vice president for public affairs, said in a statement Thursday that the issue “has come to the attention of state regulatory authorities” and that Penn was cooperating with those authorities, but was not specific.

Meir Lichtenstein, operations manager of the Lakewood Hatzolah, said it was possible that some ambulances had not called ahead, though it transports patients to Penn often, and paramedics typically alert the hospital when bringing critical patients.

Members of Lakewood’s tight-knit Orthodox community tend to prefer Penn’s hospital system even to closer systems in New Jersey. Penn-affiliated clinics have long had a strong presence in the community, Lichtenstein said.

But Shain said that before bringing patients to HUP on Tuesday, Lakewood’s Hatzolah paramedics did call Penn, and only did so after checking for critical care beds at closer hospitals.

He said running the community’s ambulances during the pandemic has been like trying to get help for victims of a mass casualty event. Twenty of its 150 volunteers have contracted the coronavirus, he said.

Hatzolah ambulances from Lakewood have also taken coronavirus patients to Thomas Jefferson University Hospital in Philadelphia and Nemours/Alfred I. duPont Hospital in Delaware, Shain said.

Lakewood has one of New Jersey’s higher concentrations of COVID-19. NJ.com reported Thursday that five rabbis from the town have died. Police there have also charged more than a dozen people with organizing large gatherings, including an Orthodox engagement party and funeral, despite the state’s stay-at-home order.

But members of the Orthodox community say they’ve been vilified for the actions of a small percentage of the town’s 70,000 Orthodox residents, out of a population of 110,000.

The overwhelming majority are observing the rules of social distancing, Shain said, although it took people a while to fully understand how serious the virus is. On March 9, before strict measures had been put in place by authorities, many people in town attended celebrations for Purim, a festive Jewish holiday. So much of life in Lakewood’s Orthodox community is communal by nature, he said, with large families whose children play together, and prayers three times a day at synagogues that hold up to 1,000 congregants.

“The message wasn’t really out there then. I wish it was. It just takes time for everything to trickle down. When we saw [coronavirus infections] taking place in New York and North Jersey initially, it didn’t make the impression on everybody — not just the Jewish community, but everybody across the board," he said. Now, he said, families with eight and 10 children are staying home without TV and the internet, which the community avoids.

Shain said he believes his father, one of the founders of Lakewood’s Hatzolah, contracted the virus after delivering food to an elderly shut-in with no family. The man died of coronavirus about a week ago, Shain said.

He said his father, though very ill, has been receiving “incredible” care at HUP and has not required a ventilator.

Staff writer Laura McCrystal contributed to this article.