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A hospital is suing a quadriplegic 18-year-old to make her go to a nursing home

MARY LOUISE KELLY, HOST:

In North Carolina, there's an 18-year-old woman who has had to live in a hospital since she was 13. Now the hospital is suing her to leave. She wants to live somewhere else, too, but not where the hospital says. NPR investigative correspondent Joseph Shapiro explains.

JOSEPH SHAPIRO, BYLINE: From her hospital bed, Alexis Ratcliff asks the question.

ALEXIS RATCLIFF: What 18-year-old gets sued?

SHAPIRO: What 18-year-old gets sued? It's hard to hear Alexis. Her voice is soft and the whoosh of the ventilator, the machine that keeps her breathing, is harsh.

(SOUNDBITE OF MACHINE WHOOSHING)

SHAPIRO: Alexis Ratcliff was sued by this very hospital. It wants her to leave.

RATCLIFF: But I didn't ask to be here. It wasn't my choice. It wasn't my decision. I didn't want to be here. But unfortunately, I'm the one that got sued.

SHAPIRO: Alexis is a quadriplegic. She can't move anything below her neck. That's why she needs that ventilator to push oxygen into her lungs. She came to this hospital in Winston-Salem, N.C., when she was 18 months old after a car crash. Doctors here saved her life. Her mother was driving that car. She was high, got charged and went to prison. Alexis was sent home to live with other family, but that ended when her grandfather had serious health problems and moved to an assisted living facility.

So in 2019, at the age of 13, Alexis Ratcliff returned to this hospital, Atrium Health Wake Forest Baptist. Except for one six-month break, she's lived here ever since. Now the hospital says it's time for her to go. It found a bed for her in a nursing home in another state. Alexis, who became her own guardian when she turned 18 last summer, said no. The hospital then sued her for trespass.

RATCLIFF: OK, Siri, FaceTime Apple.

SIRI: Starting a FaceTime call to Apple.

SHAPIRO: Alexis wants to get out of the hospital, too, but not to live in a nursing home far away. Every day she calls her sister Apple.

RATCLIFF: I bet you money she's on the phone with her boyfriend.

SHAPIRO: From her hospital bed, she uses her voice to control her iPad and iPhone. With technology like this, Alexis wants to live in her own home or apartment close to family.

RATCLIFF: Why don't you play basketball?

APPLE: Because I can't shoot a basketball in a hoop.

RATCLIFF: Well, that's an issue.

SHAPIRO: Alexis will need a lot of caregiving support at home, probably 24 hours a day - aides to watch that her ventilator works, that her trach tube, which sends air to her lungs, doesn't get clogged, someone to move her in bed and in her wheelchair so she doesn't get painful pressure sores. Still, care at home is usually cheaper than what it costs for a disabled person like Alexis to live in that hospital or a nursing home.

RATCLIFF: Love you, bye.

APPLE: Love you, bye.

SHAPIRO: At the hospital, Dr. Kevin High, who until recently was president here, says this isn't about money - Medicaid pays for Alexis. But a hospital isn't a place for people to live long term. And he says the ICU at Wake Forest Baptist Hospital is already crowded.

KEVIN HIGH: We always have people waiting for beds and especially ICU beds, and we've not had full capacity to do that when you have people who stay in the hospital for a very long period of time like this.

SHAPIRO: Alexis says, she still needs the bed, too. One thing to note, since Alexis came back to the hospital in 2019, the level of care here has been excellent - no bedsores, no respiratory infections. Those can be common and deadly for a quadriplegic on a ventilator. And the nurses, doctors and staff have been some of her biggest supporters and best friends.

(SOUNDBITE OF MUSIC)

SHAPIRO: Last spring, when she graduated high school, they threw a big party. And in August, when she turned 18, staff on the pediatric side threw her an even bigger birthday party. The next day, the hospital moved her to the adult side of the hospital and upped the pressure to force her to a nursing home it found in Virginia after no nursing home in North Carolina would take her.

LISA NESBITT: But right now, there is no known path back for her if she leaves the state.

SHAPIRO: Lisa Nesbitt is one of Alexis' lawyers at Disability Rights North Carolina. She says if Alexis moves to a nursing home in another state, she becomes a citizen of that state and gives up her North Carolina Medicaid. That would make it unlikely she could return to North Carolina. The lawyers went to court and won an order that stopped the hospital from immediately moving Alexis out of state, at least for now.

JOONU COSTE: She absolutely can get that care at home.

SHAPIRO: Joonu Coste is another lawyer at Disability Rights North Carolina. She notes that the state of North Carolina sent aides to help Alexis when she lived in her grandfather's home for all those years before she came back to the hospital.

COSTE: It's all possible, but Medicaid has to step in and help put this package together for her.

SHAPIRO: There's another key player here, the state Medicaid agency. It's responsible, even required by the federal government, to help people like Alexis Ratcliff get long-term care in their own homes, not in a hospital or a nursing home. NPR asked to speak to someone at North Carolina's Medicaid agency about what they're doing to help Alexis get out of the hospital. The answer we got back? No comment.

UNIDENTIFIED PERSON: Alexis Faith Ratcliff.

(CHEERING)

SHAPIRO: Last spring, Alexis graduated from her high school in a rural county north of Winston-Salem. Alexis and her lawyers say the hospital warned, if you leave the hospital, we won't let you back in. It took a judge's order to let her attend graduation. She took classes online from her hospital bed, graduated with honors, made National Honor Society. She won a full academic scholarship to college...

(SOUNDBITE OF BELL)

SHAPIRO: ...At nearby Salem College, a small women's school with red brick sidewalks and buildings dating back to the 1700s. Susan Ratcliff is Alexis' aunt.

SUSAN RATCLIFF: This is absolutely one of the most beautiful places in Winston-Salem.

SHAPIRO: She meets Alexis' faculty adviser, Diane Lipsett.

DIANE LIPSETT: We talk a lot here. All of my colleagues talk about meeting students where they are. Sometimes that's metaphorical or - but with Alexis, it means a different space, too.

SHAPIRO: When Alexis couldn't leave the hospital for office hours, Lipsett took office hours to Alexis in her hospital room. Lipsett and the school have worked to make Alexis successful as a student, setting up those online classes for now and thinking out how to move classes to wheelchair-accessible rooms if Alexis can one day get on campus. Alexis' aunt says until she lived in the hospital, Alexis got on a bus every day to go to middle school.

RATCLIFF: She loves people, and she would love to be here with her peers. She has missed out on so much of that.

SHAPIRO: Alexis agrees.

RATCLIFF: Yes, I am a quad, but I'm still a normal human being just like everybody else. And I should be able to live life to the fullest of my ability.

SHAPIRO: Now Alexis Ratcliff wants to get out of the hospital, to avoid the nursing home in another state, and to move into a place she can call home.

Joseph Shapiro, NPR News.

(SOUNDBITE OF COCONUT RECORDS AND WOODY JACKSON'S "DAKOTA") Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Joseph Shapiro is a NPR News Investigations correspondent.