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Our Case Manager: Helping A COVID-19 Patient Miles Away

When Robin Hughes, R.N., a nurse case manager for Arkansas Blue Cross and Blue Shield, was first assigned to help David*, a member in Minnesota, she didn’t realize the struggle he had already gone through to survive.

She received a referral on David on September 28, 2020, but his healthcare journey started six months earlier, as COVID-19 began to ravage his lungs.

David, in his 40s, lived with his dog in a sparsely populated part of Minnesota, but he worked at a factory across the state line in North Dakota. He was overweight, and COVID-19 hit him hard. After a short hospital stay in late April, he was discharged home and told to follow up with his doctor in early May.

“He didn’t keep his follow-up appointments because his illness got worse,” said Robin. “He wasn’t able to walk his dog, maintain his home or care for himself. He lost 150 pounds in 60 days.”

David struggled alone in his home until his parents traveled from Illinois to Minnesota to check on him.

When they arrived on July 7, they immediately called an ambulance. He was taken to the nearest hospital, where doctors discovered that he had suffered a collapsed lung due to a lack of proper nutrition. He also had to have part of his intestine removed. After a few weeks, David moved to a nursing facility for rehabilitation, where he stayed until late September. But just as things were looking up, another curveball hit David.

“He was getting ready to go home, and he started getting short of breath. They discovered he had another collapsed lung,” said Robin.

David was readmitted to the hospital, where they inserted a chest tube and then put in a Heimlich valve, which prevents air from traveling back along a chest tube.

That’s when Robin got involved.

“The first thing I did was contact the hospital facility where he was and talk to the case manager there,” said Robin. “I needed to know his condition: What are his needs? When can he go home? Where is he going? My first course of action was to let them know that I’m here and to please keep me updated.”

Robin began reviewing David’s case to get up to speed. In the meantime, David was discharged and opted to stay with his parents. He flew to Illinois on a Saturday and Robin called him the following Monday.

She began by asking him about his immediate needs. His response was a little shocking.

“He told me, ‘I have a valve in my chest, and I think  they were supposed to take it out,’” Robin said. “He is the only person I’ve ever dealt with who was      discharged with a Heimlich valve still in place.”

She immediately went to work and discovered there  were more hurdles to cross than she initially realized.

“David’s case was really different because so much happened before I ever got the case,” Robin said. “Plus, it was so complicated because he lives in Minnesota, works in North Dakota and was staying in Illinois — I was dealing with three different states.”

Some states recognize the licenses of case managers from other states. Minnesota doesn’t.

However, Robin is licensed in multiple states, including Minnesota.

“You have to be specifically licensed in Minnesota; that’s how the case came to me in the first place,” she said. “There are a few states that don’t honor your home-state license, and Minnesota is one of them.”

Robin called the hospital to get the surgeon’s name. She called the surgeon’s office and received a referral to a pulmonologist (lung doctor) in Illinois to remove the Heimlich valve. She found an in-network primary care physician in Illinois and set up David’s medications. After that, she spoke with David again.

“We always ask, ‘What is your goal for your health?’” Robin said.

David’s first request was about his home.

“He told me that when he was unable to care for himself and his dog, conditions in his home became unliveable,” Robin said. “He needed help getting that cleaned up so he could return.”

David had contacted a local contractor for a quote on deep cleaning and decontamination, but it would have cost more than he could afford. Additionally, he fell behind on his mortgage payments and worried about foreclosure.

Robin contacted the Tri-Valley Opportunity Council in David’s home county, where she was directed to the Minnesota Department of Housing and the Minnesota Department of Public Safety. With Robin’s help, David received assistance with his mortgage, utilities and cleaning his home.

According to Robin, David is doing very well.

“David is unusual because he followed everything I told him to do,” Robin said. “If I told him to call his doctor, he called his doctor. If I told him to call the housing authority, he called the housing authority. That almost never happens.”

David returned home with his dog just after Christmas and continues to participate in outpatient therapy. He hopes to return to work in March.

“This has been a complicated but extremely rewarding case management case,” Robin said. “It has taken all disciplines to reach David’s goals, and I’m proud that we have made an impact. COVID-19 has been devastating to many Americans, and I know our case management programs make a difference to affected members throughout the United States. David’s is a real recovery success story.”


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