(NEW YORK) — As Hurricane Ian pounded the West Coast of Florida, Tiffani Henning watched the Category 4 storm from the third floor of Golisano Children’s Hospital in Fort Myers.

Henning huddled with about two dozen other moms last week as they watched their cars float away from the hospital’s parking garage, boats float down what were once roads in front of the hospital and trees sway sideways and completely uproot from the ground.

Behind them through it all laid their newborn children, some of them critically ill, in the hospital’s neo-natal intensive care unit, or NICU.

“We were right in the eye, right in the path of destruction,” Henning told ABC News of the hospital, which is located less than nine miles from Sanibel Island, which suffered much of the storm’s most devastating damage. “You’re already in a situation of being a NICU mom and now you’re in the position of being a NICU mom in the middle of a hurricane.”

Less than 48 hours before, Henning said she barely made it to the hospital to be able to ride out the storm with her twin sons, Paxton and Kamden, who were born in August, around three months premature.

Henning was preparing her Bonita Springs home for the hurricane on Monday, when she made a last-minute decision to drive the 35 minutes back to Golisano Children’s Hospital that same day. She made it just in time before a state of emergency was declared in Lee County and the hospital was locked down to visitors.

During the storm, Henning said she and fellow moms of NICU patients became worried as the hospital’s first floor took on water and a call came over the loudspeaker for people on that floor to find higher ground.

“I’m like, if this water keeps rising, how are we getting the babies, because there were so many babies that were in the NICU,” recalled Henning. “If the water keeps going up, there’s only so many floors we can go up to before there are no more floors.”

Inside the same NICU, Jennifer Morales Uparela spent much of the hurricane in a chair next to the isolette where her 1-month-old daughter, Allison, slept.

Morales Uparela said she tried to sleep too in order to help pass the time quickly. A native of Colombia, she was experiencing her first hurricane and doing so alone in a foreign country.

“I’ve never experienced something like this, and this is my first baby,” Morales Uparela told ABC News through a translator. “What kept me going is I know that my baby needs me.”

Morales Uparela, who had a high-risk pregnancy, was staying with family members in Cape Coral, Florida, when she was induced at 37 weeks on Sept. 4. Allison weighed 3 pounds, 13 ounces, at birth and was taken immediately to the NICU, where doctors have monitored her ever since.

On Sept. 28, the day of the hurricane, Morales Uparela said she went downstairs to get something to eat, and saw the flooding on the hospital’s first floor.

“People did a good job of staying calm and the staff did a great job of keeping everyone under control,” she said. “But I went back to the unit, and that’s when everything started going downhill.”

A ‘Herculean effort’ to evacuate dozens of babies

Hurricane Ian, which devastated parts of Fort Myers and the surrounding area, killing over 100 people, caused Golisano Children’s Hospital to lose both power and water.

The hospital had a generator that kicked in at the time of the power outage, but lacking water, it began the process of evacuating its NICU patients.

Directly across the state, in the cities of Miami and Hollywood, two children’s hospitals went into overdrive, activating their plans to begin treating the evacuated babies.

The hospitals — Nicklaus Children’s Hospital in Miami and Joe DiMaggio Children’s Hospital in Hollywood — had been planning for the past week as Ian’s path was formed, working with hospital leaders across the state to figure out who could accept patients.

“We started to hear that they were going to evacuate due to infrastructure issues and that is the point where we started thinking, okay, this is real. They’re really going to need those patients out,” said Caitlin Beck Stella, CEO of Joe DiMaggio Children’s Hospital. “As soon as the hospital said, ‘It’s time to evacuate. It’s unsafe,’ everyone just jumped into motion.”

In addition to figuring out where the babies would go, hospital officials had to figure out how the babies would get there.

One obstacle was that some roads and helicopter landing areas were unusable due to the storm. A second obstacle was that patients as small and critical as NICU babies are considered “complex transports,” explained Dr. Marcos Mestre, vice president and chief medical officer of Nicklaus Children’s Hospital.

“They are essentially mini-ICUs that travel with the patients,” Mestre said of the hospital’s two helicopters and six ambulances that were used to transfer NICU babies.

In addition to the medical equipment, each patient travels with a transport team that consists of nursing staff and a medical coordinator.

“Every single case is unique,” said Beck Stella. “Some of them are singletons. Some of them are multiples, so you have to think of how do you keep families together. You can’t send one twin to Tampa and one twin to Joe DiMaggio.”

Early Thursday, hospital officials said they got the green light that the roads and helicopter landing pads were safe.

That began a 48-hour effort of helicopters and ambulances flying and driving back and forth across the state of Florida to transport patients, according to Mestre and Beck Stella.

While the roads were safe, the ambulances were often dodging debris on the ground from the storm, both officials said.

“I think our ambulance drove back and forth across the state 10 times, just back and forth,” said Beck Stella, whose hospital is located about 150 miles away from Golisano Children’s Hospital. “We even had people from other parts of the state and from outside the state that started jumping in and being able to transport these babies safely.”

She continued, “It was a Herculean effort.”

In total, 61 NICU patients were transferred from Golisano Children’s Hospital to hospitals in other parts of the state, a hospital spokesperson told ABC News.

Nicklaus Children’s Hospital in Miami admitted six of the hospital’s NICU patients, and participated in five transfers to other hospitals, according Mestre.

Joe DiMaggio Children’s Hospital took in nearly two dozen NICU patients from Golisano Children’s Hospital, according to Beck Stella.

‘It could have been so much worse’

The evacuations to different hospitals meant more stress for parents like Morales Uparela, who had just survived her first hurricane as a first-time mom.

Morales Uparela learned on Thursday that her daughter would be evacuated to Nicklaus Children’s Hospital, but had no way to get there herself as she was told the ambulance would not have space.

It was only when the ambulance arrived at midnight to transport Allison, that the transport team told her to jump in, saying they would make room, according to Morales Uparela.

With Morales Uparela sitting in the front and nurses taking care of Allison in the back of the ambulance, the team made the drive to Miami, which Morales Uparela described as treacherous.

“There was a lot of debris in the highway,” she said. “They had to go carefully with lots of debris and trees down.”

Henning, the mom of twins, navigated the drive across Florida herself on Friday, after her sons were airlifted to Joe DiMaggio Children’s Hospital earlier that morning.

Facing a city-wide curfew, Henning said she had gone home from Golisano Children’s Hospital Thursday afternoon.

She said she was woken up by a phone call early Friday morning from the hospital, letting her know the twins would be evacuated but they weren’t yet sure to where or whether they would stay together.

Kamden was eventually evacuated first, followed by Paxton, on separate helicopters.

Henning said she and her husband made the nearly two-hour drive to Hollywood on Friday, and were able to reunite with their sons.

“There were lots of tears,” she said. “I got to hold both of them and cuddle them and knowing that they were at another place and safe was just the best peace of mind.”

Henning’s sons continue to be treated at Joe DiMaggio Children’s Hospital, but she said she is hopeful they can soon return to Golisano Children’s Hospital, which has since reopened.

The family lost a car in the storm and lost power and water at their home, but feel thankful to be alive and together.

“It could have been so much worse,” said Henning, who said she is most grateful for the medical staff that cared for her sons while their own homes and families were affected by the hurricane.

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(NEW YORK) — Sexual violence survivors may often face overwhelming medical bills when seeking emergency care, a factor that could discourage many people from seeking treatment, experts say.

Survivors of sexual violence are charged nearly $4,000 in medical bills, on average, after seeking emergency care following an assault, according to a recent study published in The New England Journal of Medicine.

Only one in five victims of sexual violence seek medical care in the United States. The study’s authors conclude that medical bills may deter victims from seeking treatment.

People without health insurance pay an average of $3,673 out of pocket while those with insurance still pay around 14% of total costs billed, an average of $497.

Pregnant women that experience sexual assault and seek emergency medical care experience the highest charges at $4,553 on average, for their visit.

These bills may particularly burden low-income women and girls, disproportionately victims of sexual assault.

“We’re discouraging people from seeking medical care when we charge them a huge amount of money for that care,” study author Dr. Stephanie Woolhandler, MD, a distinguished professor of public health at CUNY’s Hunter College, and a lecturer of medicine at Harvard Medical School, told ABC News.

“I saw a rape victim who told me that she hadn’t gone to the emergency room because she knew she wouldn’t be able to afford it,” said study author Dr. Samuel Dickman, healthcare policy researcher and primary care physician at Planned Parenthood of Montana.

Dickman tells ABC News, “the patients I’ve seen and who’ve described to me the feeling that they are completely unsupported by the healthcare system. They know they can’t access affordable care after being assaulted. For many survivors, that feels like adding an additional layer of trauma.”

Woolhandler says that people should ask for financial assistance when seeking treatment in the emergency department.

“Depending on your income, you may be eligible for financial assistance, and you often have to ask for it,” she said. Another tip from Woolhandler is “for people who are veterans to check and see if they’re eligible for care at the Veterans Administration hospitals because that care comes with very minimal copayments and deductibles.”

In this post-Roe era, women are even less protected by the healthcare system when they experience sexual assault. As of September 2022, 11 states have banned abortions, including abortions of pregnancies that resulted from rape.

“Under laws that say that rape survivors need to prove that they got medical care to qualify for an exemption to get an abortion. That means you’re asking the survivors to go to the emergency room, potentially incurring thousands of medical debt to access abortion. It’s totally inhumane,” said Dickman.

“We need to reform the Violence Against Women Act to cover medical care, comprehensively, not just for the forensic exam,” Dickman said.

The Violence Against Women Act is a federal law that pays for evidence gathering but leaves people responsible for additional bills associated with emergency care following an assault. Broadening provisions of the Violence Against Women Act to include payment for other services, not just evidence collection, could help survivors avoid financial hardship and further trauma.

“Tragically, our political system continues to fail survivors of rape and sexual assault,” said Dickman.

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