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Bomb's medical costs could be in the millions, experts say

As surgeons and physicians worked to mend nearly 70 hospitalized victims of the Boston Marathon bombing, a new toll emerged: The total medical costs inflicted by the attack may eventually reach or surpass $9 million, according to a rough calculation.

The precise health-care price tag won’t be fully known for months as some of the injured, particularly those who lost limbs, undergo extended rehabilitation (which can cost more than $200 per hour) to re-learn walking. Much also depends on whether mental-health experts begin to see witnesses or survivors who struggle with post traumatic stress disorder

“Some of these people suffered very severe injuries. It was all hands on deck. Doctors were trying to save their lives,” said Ted Miller, a senior research scientist with the Pacific Institute for Research and Evaluation. “This is going to be really expensive.”

In all, 69 bomb victims remained at Boston hospitals on Wednesday, including 19 people in critical condition. Among them, 17 are reported to have catastrophic wounds, meaning the loss of limbs. The severe nature of those blast wounds could take some patients over their own health-insurance caps, experts say.

More than 100 people were treated at Boston hospitals and released. The total medical care calculations don’t take those people into account.

After the 2011 Tucson shootings that killed six people and wounded 18, including former U.S. Representative Gabrielle Giffords, health-economist Ted Miller calculated that the average cost for a person injured by gunfire was $48,610 – or about $50,000 in 2013 dollars.

“One of the commonalities with that and what happened in Boston is that gunshot wounds these days are very often multiple rounds, and the blast injuries were probably multiple injuries (due to shrapnel) that tended to enter multiple parts of the body,” Miller said.

“It’s probably on the magnitude of $40,000, $50,000 (per person for emergency-room care). But for the people who will be hospitalized for weeks, you could easily be looking at $150,000 to $200,000 per person,” he said.

For those who have lost limbs, prosthetics are pricey: $14,187 for a partial foot, $16,690 for a lower leg, and $45,563 for a full leg, according to a 2010 report by the Journal of Rehabilitation Research & Development.

For children who lost legs, the costs are even higher because prosthetics must be replaced several times as they grow. Costs for lower-extremity prosthetics from the time of injury until age 18 may range from $73,140 to $116,040 per leg, according to the Journal of the American Medical Association.

How will these bills be paid?

A blend of million-dollar donations, Massachusetts’ mandatory health insurance – and perhaps an agreement by Boston hospitals and insurance providers to eat some bills – may compose the safety net that ultimately covers the staggering medical costs, say mass casualty experts.

For some advice, Boston may even turn to leaders in Aurora, Colo. where last July a gunman killed 12 and wounded 70 people in a movie theater. Many survivors and their families have struggled with gaps in medical care, said Rich Audsley, special advisor to the 7/20 Recovery Committee, which oversees a fund for Aurora’s victims. 

“This is an opportunity for Boston, a very unique moment,” Audsley said. “If you have the right leadership quotient around the table from the community, they can have an honest dialogue: ‘What is it that we can do?’ That’s the place to begin.

“It’s what’s reasonable. For example, hospital administrators and insurance companies (can agree) to forgive some of the medical expenses for who those who don’t have insurance. They can come together to try to minimize the pain and suffering of the people who’ve been impacted,” added Audsley, a long-time United Way official. After the Aurora theater massacre, such talks were held with Denver-area hospitals and insurance providers.

The Aurora Victim Relief Fund collected $5.3 million in donations and has given $220,000 to each of the families of the 12 who died and to five victims with permanent injuries. The fund also gave $160,000 apiece to six people who were hospitalized for at least 20 days and $35,000 apiece to 13 survivors who spend up to a week in a hospital.

On Tuesday, Boston Mayor Tom Menino announced One Fund Boston, an effort to raise money for families most affected by the attack. The John Hancock company has pledged $1 million, and other commitments for contributions also came from the Boston Celtics, Boston Red Sox and Bain Capital.

“We are one Boston. We are one community. As always, we will come together to help those most in need. And in the end, we will all be better for it,” Menino said.

The fund will be designed and run — pro bono — by attorney Kenneth Feinberg, who in 2001 was appointed to administer the September 11th Victim Compensation Fund. Massachusetts Gov. Deval Patrick and Menino made the announcement Wednesday. In 2010, Feinberg was tapped by President Barack Obama to head the BP oil spill fund. Feinberg is scheduled to arrive Friday in Boston to launch that work

It’s unclear whether the five Boston hospitals now treating more than 70 bomb victims will eventually opt not to bill for some of that care. At Brigham and Women's Hospital, where 31 patients passed through briefly after the explosions and where 14 were admitted, spokeswoman Jessica Maki said: “We have not even begun to have the discussion. Still caring for patients."

But Massachusetts is rare in that residents 18 and older must have health insurance. They are hit with tax penalties if they don’t acquire minimum coverage. For Massachusetts’ citizens whose income falls below 150 percent of the federal poverty level, Commonwealth Care pays the total cost of their health insurance. It’s the model for the 2010 health reform law.

“Massachusetts has perhaps the best health insurance in the country, so that will help (fill many medical-cost gaps),” Miller said.

Two brothers who attended the Boston Marathon – Paul Norden, 31, and his brother, J.P., 33 –are local roofers who recently lost their jobs. Each lost a leg in the blast.

“But there were people from all over the country at the marathon. It’s a national event,” Miller said. And visitors from other states don’t fall under Massachusetts’ health-care law. “I suspect, if any of those people were hurt, they will be some of the ones whose bills will be waived by the hospitals.”

One other unique factor in Monday’s bombing: most or perhaps all of the victims were pedestrians on sidewalks as opposed to students, like those wounded at Columbine in 1999 or Virginia Tech in 2007 and who fell under the school-insurance policies, or like the federal workers hurt in the 1995 Oklahoma City bombing who qualified for workers compensation coverage, said Robin Finegan, who was regional administrator of the Federal Emergency Management Agency’s Denver office at the time of the Aurora shootings

If any marathon volunteers or workers were hurt, they theoretically should be covered by the event’s insurance policy, and any Boston city employees who were injured would be eligible for municipal insurance coverage, Miller said.

“Unlike Columbine or Oklahoma City, on the street in Boston, there’s no connection, no business, no entity that has any liability or responsibility,” Finegan said. “This is just a random, on-the-street crime.”