Army Spc. Daysha Cartagena and her husband, Staff Sgt. Isaiah Cortez, were looking forward to the birth of their daughter in October 2021. The pregnancy hadn't been easy; Cartagena's legs and ankles were swollen, and her blood pressure had been erratic.
When she began feeling contractions, Cartagena went to Womack Army Medical Center at Fort Liberty, North Carolina, where she was examined and sent home, told she wasn't ready yet to have her baby. She repeated the process two more times before finally returning to Womack, her contractions coming in painful waves seconds apart, the baby's heartbeat plummeting with each squeeze. Again, she was told she wasn't dilated enough to give birth, but by then, she was leaking brown, bloody fluid, and she was allowed to stay at the hospital.
It was the middle of the night, and Cartagena was given medication to move the process along. By 6 a.m., the doctors on call decided she needed an emergency Cesarean section. Three hours later, she had the surgery, but by then, her daughter's heartbeat was faint, she was pale and barely breathing.
"She was blue. She didn't scream. And there was this sudden shift inside the room as [the staff] looked at each other. It's like panic inside that room," Cartagena said during a recent interview with Military.com.
Cartagena's daughter's Apgar score -- a health assessment of a baby at birth on a 10-point scale, with 10 being the goal -- was 2.
The baby, Mya, was flown by civilian helicopter to WakeMed in Raleigh, North Carolina, where she was placed on extracorporeal membrane oxygenation, or ECMO, a process in which a person's blood is removed from their body, scrubbed free of carbon dioxide and then oxygenated and circulated back through.
It had been determined that Mya had inhaled and swallowed meconium -- a baby's first bowel movement -- during labor, which can cause constriction of the airways, respiratory distress, pneumonia, brain damage resulting from an oxygen deficiency and death.
Mya's parents believe the problem was tied to the long labor and delayed C-section.
The baby was transferred to Duke Medical Center, where she spent two weeks on ECMO and six weeks total, hospitalized.
Then the bills came: $12,166.40 for the air ambulance; $61,634.80 from WakeMed; $594,564.88 from DukeHealth.
The dual military couple uses sick call or military health facilities for their own health care and never had seen a medical bill for themselves. They contacted the Defense Enrollment Eligibility Reporting System and the Defense Department's health program, Tricare, to ensure that Mya was enrolled. They sought help from customer service at Womack and legal experts.
Nothing worked. When the collections letters and calls started coming -- at home, at work, on the couples' cell phones -- Cartagena asked other Army moms on social media about medical debt, but no one seemed to be facing such enormous bills.
In frustration, Cortez turned to Reddit, posting a snapshot of the latest balance he owed Duke: $633,455.81.
"We've been dealing with tricare [sic] for over a year trying to get them to pay the medical bills and they keep giving us the run around saying that it's been resolved but a month later we'd get calls from billing telling me the authorizations have been denied," Cortez posted. "Has anyone dealt with this before or know which avenues I can take?"
He received a slew of responses and upvotes, offering suggestions, advice and empathy.
And then one response, from Sergeant Major of the Army Michael Grinston's public affairs shop, wrote "Dm me."
Cortez sent a direct message. And within hours, he said, "Magically everybody wants to help." While Grinston's office does not respond to every plea for assistance or complaint from soldiers on the internet, the enormity of the bill and Cortez's own admission that he had contacted Tricare and was being told he needed to complete a malpractice claims form with Womack before the civilian bills were paid drew Army leadership's attention, according to a service member familiar with the proceedings who spoke on the condition of anonymity to discuss internal Army deliberations.
More than 100 million American adults -- roughly four in 10 -- have outstanding medical bills, debt worth more than $195 billion. Not only is carrying excessive medical debt stressful on family members and household budgets, it can prevent patients from receiving health services in the civilian sector and ruin credit ratings, making it difficult for those who carry it to qualify for a home or car loan or prevent them from getting an advanced degree, according to a 2022 survey by the Kaiser Family Foundation, a nonprofit that focuses on health issues.
Service members in theory face less of a risk of medical debt, given the health care promised them by the military branches, but the fact that many use some combination of base and civilian care can lead them down a path toward debt as well.
Officials contacted leadership at Fort Liberty and learned that baby Mya's case had fallen through the cracks. She had not been assigned a case manager to help the family with the complexities of medical billing, and her mother's records were incomplete, missing information as a result of a changeover to the Defense Department's new electronic health records system, MHS Genesis.
Now, Womack and Tricare are working with the couple and the private hospitals to solve the claims and to clear the couple's credit reports of any red flags generated by the long-standing billing issues.
"We have the best Soldiers in the world and I'm happy to advocate wherever I can," Grinston said in an email to Military.com. "Anytime a Soldier has an issue, I'd ask they keep their leaders engaged and give them the opportunity to counsel and mentor. Those leaders should escalate to the appropriate level on behalf of their Soldiers."
Military.com contacted the WAMC press office on Friday to ask about the billing. A public affairs officer on Monday said the commander was being briefed that afternoon on the case, and they would respond to a request for information following the briefing.
On Tuesday, Shannon Lynch, a public affairs specialist with WAMC, provided the hospital's response: "Womack Army Medical Center is working with the family and TRICARE to help resolve the issue," Lynch wrote.
When pressed to answer specific questions about the case, Lynch cited the law that protects a patient's right to privacy regarding their health information, the Health Insurance Portability and Accountability Act.
She did not answer generic questions about WAMC's policies regarding case manager assignments or assisting patients with Tricare billing -- questions that do not involve patient privacy concerns.
"Womack Army Medical Center honors every patient's privacy by following Health Insurance Portability and Accountability Act (HIPAA) laws and associated regulations," Lynch wrote in a followup email to Military.com.
A spokeswoman for Humana, the contractor that manages the Tricare East Region, described the case as a "complicated situation" and requested more time to respond, but did not by publication.
Cartagena believes that her delivery delays were linked to staff shortages in Womack's labor and delivery department. When changing duty stations to Fort Liberty, she faced difficulties getting an appointment and went six weeks without a prenatal checkup.
Across the Defense Health Agency, numerous obstetrics and gynecology units have faced shortages. In April 2022, providers at Camp Lejeune, North Carolina, reported that staffing shortages were delaying appointments and pushing patients to civilian medical facilities more than an hour away, and in one case reported by Military.com, a Marine wife went 12 weeks without a prenatal appointment after moving to Camp Lejeune from Quantico, Virginia.
At Naval Hospital Bremerton in Washington, closure of labor and delivery negatively affected patients, including a service member who miscarried after spending eight hours in a waiting room at a civilian facility.
And earlier this month, pregnant mothers at Kadena Air Base in Japan were told to plan for delivering their babies at a civilian Japanese hospital or return to the continental United States for their deliveries.
While the Defense Health Agency said that hospital diversions were unnecessary, the announcement highlighted the severe, acute staffing shortages at Naval Hospital Okinawa, which provides the bulk of medical care to U.S. service members and their families on the island in the Japanese archipelago.
In 2017, Congress gave the Pentagon broad authority to reevaluate and potentially scale back military medical facilities and outsource more care to the communities surrounding bases.
In some areas, such as Bremerton and Okinawa, military leaders have had to rethink the reform efforts. In March, Lester Martinez-Lopez -- assistant secretary of defense for health affairs -- said the Defense Health Agency is working to "increase the efficiency" of clinics in Japan so that more appointments are available.
Also in March, Navy Secretary Carlos Del Toro said the service would review downsizing at Naval Hospital Bremerton to ensure that all health services can continue.
"I want to assure you that I personally have discussed this with the Office of Secretary of Defense, with the deputy, with the secretary of defense himself," Del Toro said during a hearing before the House Appropriations Defense Subcommittee.
Cortez and Cartagena say they are considering filing a claim under the Federal Tort Claims Act for malpractice they believe resulted in Mya requiring a feeding tube for the first four months of her life and treatment that damaged her vocal cords.
Cartagena wants some accountability at the hospital, which she said has lost many of her medical records during a changeover to a new electronic medical records system, MHS Genesis.
"Womack [at one point] was saying that my daughter was never born in the hospital. How do you mess that up? I literally had [a] C-section there," Cartagena said. "And now they said I had my C-section on Oct. 6, 2021, which is false because my daughter was born Oct. 24."
Nonetheless, the parents said, they are grateful for their Army units, which provided assistance they described as "great" and "so supportive," and feel blessed that the Sergeant Major of the Army's office helped them.
Still, they said, it shouldn't have taken a "powerful man" intervening to get their problem fixed.
"No one [at Womack or base legal] ever said, 'Hey, there's an office that you can go to that will help submit a claim for your daughter,'" Cartagena said. "It's really sad."
Nearly 2, Mya is a healthy toddler who continues to have issues swallowing but otherwise appears to be on track developmentally and physically.
Grinston, who is expected to retire from the Army in August, said he was glad to help.
"I'm glad to hear Mya is doing much better and I wish all the best to Daysha and Isaiah throughout their careers," Grinston wrote in a statement to Military.com.
-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime.