A 28 Year Old Physician Died From Covid-19. Her Death Exposes The Harsh Realities Of Medical Training

Adeline Fagan, MD was five years old when she decided to become a physician. Her dream was cut short on September 19, 2020 when she died of Covid-19 after a two month hospitalization fighting for her life. She had recently graduated from University at Buffalo Jacobs School of Medicine and was an obstetrics/gynecology resident at HCA Healthcare West in Houston, Texas.

Losing a daughter is a tragedy no matter what the cause of death. And yet, the “why,” “how,” and “what could have been different” of the aftermath compounds the family’s grief. After burying their daughter, Dr Fagan’s parents are now dealing with hospital bills and student debt, from an illness their daughter arguably caught while caring for patients in the hospital’s emergency room. Their GoFundMe account has raised nearly $200,000 to date to help cover the costs.

Residents are physicians who have received their MD or DO degree and are employed by hospitals in government-funded positions, during which time they are considered to be “training” for a specific medical specialty. They are historically underpaid and overworked, often justified by the idea that they are quasi-students.

A resident’s employment can be compared to indenture servitude, because they sign up for 3-7 years of working for a specific program, and completing the work successfully dictates the viability of their future career. A resident who is unhappy with their hospital cannot find a new residency position easily, and switching positions is at minimum discouraged, if not nearly impossible to pull off. But while indentured servants completed their contract without loans, the average medical student debt is $251,600. (Note that Dr. Fagan’s parents say her overall student debt was even higher at $300,000).

Many residents were “deployed” to work in understaffed Covid-19 wards, taking care of patients they normally would not have been exposed to. Imagine dermatology residents taking care of patient’s lung problems, and OB/GYNs taking care of patient’s intubations. The issue is not about patients’ risk, as supervision is available to those who needed help managing patients. More importantly, what’s troublesome is the lack of autonomy. If a physician signed up for a neurosurgery residency, should they be required to put themselves at higher risk for catching Covid-19 by being “deployed” to another hospital service?

Assigning residents to care for Covid-19 patients was a widespread tactic during the pandemic. A survey of NYC residents reported that 74.7% were “redeployed from their regular hospitals responsibilities to support COVID-19 efforts.” Sixty percent of residents reported their protective equipment (PPE) was “suboptimal.” 

Using the word “deployed” is abusive to trainees. Mobilizing trainees to cover Covid-19 floors put them at serious risk for contracting the disease themselves, both by increased exposure to the number of sick patients and also because few had adequate PPE. But residents- and their families- are not in the armed forces, the setting in which the word “deployed” is appropriately used. The families of servicemembers who die in the line of duty are eligible for very extensive benefits, including the $100,000 death gratuity paid to their surviving spouse, children, or parents. In contrast, residents do not generally have disability benefits, life insurance, or hazard pay.

The Committee of Interns and Residents (CIR) is the largest residency union in the US, representing 17,000 residents. They published an open letter to the ACGME and ABMS requesting protections for residents including disability coverage, personal protective equipment, childcare, and ensuring that residents are “appropriately working within their scope of practice.” NYU residents requested hazard pay, life insurance, and disability insurance in a letter to their administration; this request was denied per coverage from the NY Daily News. Susan Naranjo CIR spokesperson shared with me that during the pandemic, they received daily calls from residents who inquired how their program could join CIR, understanding how much external support they now needed.

The American Medical Association believes that residents must “be free to raise concerns about their personal safety and the safety of those around them without recrimination or consequence to their employment and training,” should receive hazard pay, and be granted student loan forgiveness.

Jacob Akerman’s financial planning firm focuses on medical trainees. He has found a significant increase in interest among trainees for disability insurance and life insurance, benefits that are rarely included in resident’s employment contracts for the hospital. “Medical residents are currently on the frontlines of the fight against Covid-19, and are putting both their physical and financial well-being in jeopardy.  If a resident contracts Covid-19 and passes away, they may leave their loved ones with loss of income and lots of outstanding student loan debt.  For those that survive Covid-19, the disease can cause lasting symptoms that affect their ability to work as well as future insurability.  Consequently, we have seen a significant increase in requests from residents for life and disability insurance, as well as requests to set up a living will.  While the pandemic has brought some of these issues to light, medical professionals have always been on the frontlines of disease, treating patients with anything from HIV/AIDS to ebola, and while we appreciate that they protect all of us, we must make sure that they are protected first and foremost.”

Regarding the tragedy of Dr Fagan’s death. Selena Mejia, HCA Houston Healthcare West spokesperson, where Dr Fagan worked, shared the following statement: “We are heartbroken by the tragic passing of Dr. Adeline Fagan. Our hearts go out to her loved ones, friends, and all of her colleagues. Dr. Fagan touched so many lives, and she will always be remembered for her happiness and beautiful smile, as well as her dedication to moms and babies.” 

Regaring Dr Fagan’s medical bills, Ms. Mejia said their hospitals do not bill patients who are diagnosed with Covid-19, whether they have insurance or not, for testing or hospital care related to the treatment of Covid-19. The hospital confirmed that she was not deployed to the ER due to Covid-19 and that the sequence of her ER rotation was planned.

Hailing our healthcare workers as heroes is appropriate and a beautiful show of gratitude for their selflessness and sacrifice. But what if those same sentiments were used as a tool to coerce workers to show up and risk their lives? What if they don’t really have a choice?

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