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For a sidebar on the difficulty of getting medical journals to publish data on border wall-fall injuries, click here.

On top of the drumbeat of COVID cases one night last October, UC San Diego Hillcrest hospital admitted nine patients "almost all at once" for crushing injuries sustained after they fell from as high as 30 feet trying to climb over the border wall to enter the U.S.

Open fractures of the tibia and feet and other lower extremities, as well as pelvic and spinal injuries, are common. There are brain injuries from skulls hitting the rocky ground. Often, open wounds fill with dirt as patients crawl into the fields from where they fell before border patrol can pick them up and summon an ambulance, making infection more likely and difficult to control.

"We had these patients everywhere," recalls the hospital's trauma chief, Jay Doucet, MD, of the flood of such patients on that weekend in October 2021.

"They filled up the trauma bay. We had them parked in the ICU. We realized most of these patients are going to need orthopedic procedures. At that point, the wheels fell off and we realized, this is getting out of hand. What's going on?"

Doucet notified executives that the trauma service, usually filled with 30 patients, was now stacked with 68, many still being treated weeks and months after sustaining border wall fall injuries.

Border patrol guards strolled the hallway too, guarding their undocumented captures around the clock, two to a patient.

What Changed?

Doucet and his colleagues decided to pull their data and realized the "humongous issue."

Since a Trump administration policy in 2019 raised the height of portions of the wall from 18 feet to as high as 30 feet, the injuries now were so much more severe and difficult to treat. The hospital had been admitting an average of one -- and sometimes two -- undocumented fall patients per day.

To convey the urgency, Doucet and his colleagues submitted a portion of their findings as a research letter to , published this April. Now, they have more .

For starters, the number of wall fall patients with trauma injury severity scores (ISS) higher than 15 -- considered major -- was seven times higher in 2021 than it was 2019.

UC San Diego executives called Doucet's report of the surge a "shocking" explanation as to why their level 1 trauma service had been so overwhelmed.

They also realized the problem was much bigger than what was being absorbed by UC San Diego. Year round, the hospital receives patients who fall off those portions of the wall built along Imperial County's 86-mile border that extends from San Diego County's eastern border to Yuma. The other healthcare system that shares in absorbing these trauma cases -- Scripps Mercy Hospital -- was seeing similar increases in wall fall numbers and severity.

A Scripps spokesperson told 乌鸦传媒 that the number had grown annually from 12 in 2016 to 41 in 2020 to 139 in 2021. As of the end of July 2022, the hospital had already admitted 141 such patients.

For the two centers, "it's basically been a 1,000% increase in border wall falls over the 6-year period," Doucet said, from 39 in 2016 to 377 to 2021, and 2022 fall injuries are on track to be even higher.

The migrants or the so-called coyotes who accompany them climb up the southern side of the wall on ladders, then pitch them over to the northern side to descend. But sometimes the ladders break under the weight. Sometimes the climbers just lose their grip.

The San Diego County Medical Examiner had no reported wall fall deaths from 2016 to 2018, but from 2019 to 2021, there , with another two confirmed deaths in 2022. Several others remain either sealed or are still under investigation.

Doucet said that prior to the wall height being raised, UC San Diego never had a patient die from a fall after being admitted to the hospital. Now, for some severely injured individuals, the best hospital care and surgical skill can't save them.

Quality of Care Affected

This isn't just another political controversy from the Trump administration, Doucet argued. It's also an issue that lowers the quality of care for legal residents of border regions like San Diego.

Ambulance response times for domestic emergencies are delayed when 911 responders make runs to remote parts of the border to pick up border falls. And case counts put a strain on operating room availability, resulting in orthopedic and other specialty surgeons working into the night, what Doucet called "add-on" time. Scheduled and emergency surgeries for non-migrant patients -- for example people in car accidents or bicycle falls -- may have to wait.

Lengths of border fall patients' hospital stays are longer. In 2019, none of the 49 border wall fall patients at UC San Diego were hospitalized for 31 days or longer. In 2021, 11 were hospitalized for 31 days or longer. More patients required ICU care.

More surgical interventions have been required for these patients falling from greater heights too, Doucet said. In the last 2 years, some patients required as many as nine operations; whereas in 2019, only two patients required as many as four.

Some patients are in their 60s and 70s, and 22% are women, some pregnant. One migrant woman's fall resulted in her giving birth to a stillborn.

And there's the emotional impact on the hospital's care teams, who are already battling COVID fatigue, Doucet noted. They listen to their patients' stories of desperation and physical pain during what for many is an interminable recovery. Many patients suffer the agony of realizing they will never again work, or walk, or be able to manage their own lives independently.

Discharge to a rehabilitation facility that would be a routine referral for a U.S. citizen is largely unavailable to these uninsured patients, so they remain in the hospital taking up beds, time, and resources. There are so many patients under UC San Diego's care that the hospital reopened an old postpartum ward to house them, Doucet said. "These patients generally don't have insurance, and there's no place for them to go. They stay with us until they can basically be walked out of the hospital or somebody can take them."

Questioning the Rationale

The intent of raising the height of the wall was to make it so it "," which clearly isn't the case. Border patrol apprehensions and undocumented immigration were supposed to go down, but they have not.

"We've created a perfect system to create these kinds of injuries and deaths by putting up a wall and then making it the only way into the country," Doucet noted. "What (the policy) is doing is producing a large surge of trauma patients at the worst time we could have them, when hospitals are overloaded."

Under , migrants seeking asylum in the U.S. have had to return to Mexico or their home countries while they awaited a decision, based on the that keeping migrants out during this period would prevent COVID-19 transmission.

Because "there is no viable and legal way to ask for asylum, desperate people must resort to life-threatening methods to get on U.S. soil to ask for asylum," argued Linda Hill, MD, a coauthor of the JAMA Surgery research letter and executive director of Asylum Seeker Screening and Stabilization Program. She blamed Title 42, which she called "a racist and inhuman policy," for creating the situation.

Hill, who also chairs the UC San Diego-Baja Committee for COVID-19 Prevention and Mitigation, advocated for more outreach to Mexico and other countries to make more people aware "that crossing the wall is dangerous, and likely to result in severe injuries."

One solution, she noted, is for the federal government to lower the height of the walls, which she called "a humanitarian disaster. People are desperate and will not stop trying to cross."

When the Trump administration began plans to raise the wall height 5 years ago, Doucet's counterpart at Scripps Mercy, Vishal Bansal, MD, had predicted the rise in injuries. His trauma service had already started to see an increasing trend. In May 2017, with several wall fall patients being cared for and border patrol officers walking the halls, he told 乌鸦传媒 that one patient had sustained bilateral extremity fractures and had been hospitalized for weeks.

"If the wall is 40 feet high, you're not going to have people turning away," Bansal said at the time, "you're going to have people jumping off a 40-foot wall. If the wall is 50 feet, people are going to jump off a 50-foot wall. If the wall is 100 feet, people will jump off a 100-foot wall."

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