When an elderly Hawaii couple departed Yokohama, Japan, aboard the Diamond Princess cruise ship on Jan. 20, they had signed up for a two-week luxury cruise to China, Vietnam and Taiwan and a return to Japan.
What 72-year-old Catherine Heflin and her 84-year-old husband, Richard Heflin, got instead were novel coronavirus infections and a maze of international red tape and bureaucratic snafus.
“My mom was supposed to go on a fun trip … and she ended up hospitalized for 2 1/2 months,” said William “Bill” Heflin, the couple’s son and a Hilo attorney recently on a short list of nominees to become a Hilo Circuit judge.
The Heflins were among the first Hawaii residents to contract the potentially deadly virus.
For Catherine Heflin, who became critically ill aboard the Diamond Princess and was taken from the ship in an ambulance on Feb. 9, that meant being left alone in a Yokohama hospital for weeks, because no Hawaii hospital contacted would accept her as a patient.
“I was so desperate, I thought I was going to die there,” Catherine Heflin told the Tribune-Herald. “I was there two months, and it was very lonely, because it was difficult for me to contact my family.”
Richard Heflin, a retired U.S. Army Special Forces soldier, showed no outward symptoms of COVID-19 illness but tested positive after he was found to have a fever after being evacuated from the ship on Feb. 17. He was one of 14 Americans segregated from 314 other passengers aboard a military transport flight from Japan to Travis Air Force Base in Fairfield, Calif.
State Department and Trump administration officials reportedly flew the 14 infected evacuees — all of whom were asymptomatic — to the U.S. in the same aircraft with the others against the advice of the U.S. Centers for Disease Control and Prevention.
“When they evacuated the Americans from the ship, my wife was already in a hospital, and I didn’t know where she was for five or six days,” Richard Heflin said. “I didn’t want to leave, but my children told me if I stayed in Japan, I’d only be in the way.”
He said he and the others “were put in a separate room in a warehouse” at the Air Force facility. The career soldier was shuttled between two civilian hospitals and a military hospital in California before being allowed to return home to Aiea, Oahu.
On Feb. 16 at Yokohama City University Medical Center, Catherine Heflin was placed on an extracorporeal membrane oxygenation (ECMO) machine — essentially a heart-lung bypass machine — and treated with Lopinavir-Ritonavir, an HIV drug, protocols considered experimental for COVID-19 patients in the U.S.
By March 9, Bill Heflin said, his mother had been pronounced coronavirus-free in Japan, but differences in Japanese and U.S. testing protocols kept her in the Yokohama facility.
And while Catherine Heflin was originally cleared by the CDC to fly to the U.S. on March 12, she had to find a hospital willing to receive her before she could be taken aboard an air ambulance. In addition, the Japanese hospital wasn’t willing to medically clear her to fly until about two weeks later. The CDC issued a second clearance letter on March 30.
In the meantime, Bill Heflin was calling Oahu’s private hospitals in an attempt to get his mother admitted. His efforts turned up denials with only three maybes — The Queen’s Medical Center, Pali Momi Medical Center and Adventist Health Castle.
“The three hospitals said they couldn’t take her unless she had an updated test. The Japanese hospital originally didn’t want to do it because they had a limited number and she’d been cleared for weeks,” he said.
A call was made to U.S. Sen. Mazie Hirono’s office, which contacted the U.S. Embassy in Japan in an attempt to get an additional test for Catherine Heflin.
That test was finally performed and was negative — but in the meantime, maybes turned into denials, Bill Heflin said.
According to the lawyer, Queen’s and Pali Momi claimed occupancy issues, while Castle cited Catherine Heflin’s underlying renal disease as reasons for rejection.
“My mom didn’t need an ICU bed. She wasn’t (COVID-19) positive. She wasn’t likely to become positive again. So at that time, I reached out to the governor’s office,” he said.
According to Bill Heflin, Kymberly Sparlin, Gov. David Ige’s policy director, was “very helpful.” He said Sparlin contacted Dr. Linda Rosen, CEO of Hawaii Health Systems Corp., which operates the state-run hospitals, and there appeared to be hope his mom would receive care in Hawaii.
“Initially, Kahuku Hospital seemed to be somewhat receptive to this idea, but later got concerned that my mom might be stuck there because of the renal issues,” he said.
Finally, Bill Heflin contacted his sister, Audrey Burke, and her husband, Dr. Timothy Burke, a neurosurgeon who practices at Anne Arundel Medical Center in Maryland. Timothy Burke said he contacted the Hawaii facilities that were maybes, and “they sort of gave me the impression that they were at full capacity.”
“I know that wasn’t true, because I’m a physician here, and our (occupancy) numbers were and are significantly higher in Maryland,” Burke said. “… She just needed things to be arranged for her transition to outpatient status. We weren’t asking for an ICU bed or anything like that. It was frustrating.
“So I asked my hospital here and, granted, it’s my hospital and I know people here. But it was just one 30-second phone call, and we were able to get her accepted for transfer.”
So on April 10, almost a month after the initial CDC letter clearing her to travel to the U.S., and more than two weeks after being medically cleared by the Yokohama hospital, Catherine Heflin was discharged from the Yokohama hospital and put aboard an air ambulance to the East Coast.
“Because she wasn’t able to go to Hawaii, what would’ve been probably an eight-hour flight ended up being a 17-hour flight,” Audrey Burke said.
Catherine Heflin received follow-up treatment in Maryland and was released from the hospital on April 17.
“She’s doing phenomenally well. She’s recovering at our home, but all things considered, she’s a rock star right now,” Timothy Burke said.
And while the medical treatment in Japan was excellent, Catherine Heflin said the language barrier and loneliness were overwhelming.
“It was over six weeks, I think, and you’re desperate because there’s no one to talk to there,” she said. “There were people who were extraordinarily kind, and then there are others who would be frustrated with me because I didn’t understand, and so there was some bullying. And I was alone and very frightened some of the time.”
Catherine Heflin realizes that, loneliness aside, she was fortunate to have been treated with a protocol she likely wouldn’t have received in the U.S.
“I’m so grateful to Dr. Hayato Taniguchi, who saved my life,” she said. “Dr. Taniguchi took a chance on me and used the ECMO machine.”
Taniguchi and his colleagues published a paper on her case in the online journal Acute Medicine and Surgery.
The Aiea woman said she was shocked to have to fly to Maryland instead of Hawaii for follow-up care.
“How could they not accept me? I was just devastated,” she said.
Richard Heflin said he was “very angry” his wife was denied care in Hawaii.
“And what upset me was, during the time my wife was still in Japan, there was an article in the newspaper that said only about 30% of the hospital beds in Hawaii were occupied. That really ticked me off,” he said.
Bill Heflin is grateful his mother is on the mend, but incredulous there wasn’t a hospital bed for her on her home island.
“It’s ironic that my mom is Native Hawaiian,” he noted. “She’s paid her taxes here her entire life. And there was no aloha for her in the Aloha State.”
Email John Burnett at jburnett@hawaiitribune-herald.com.