By David Gambacorta and Helen Ubinas

The Philadelphia Inquirer

PHILADELPHIA — Whenever Jalil Frazier opened his eyes, he found himself on an island barely wide enough to contain his frame, boxed in on both sides by unforgiving metal bars. A familiar landscape surrounded him: four bare walls, a beige tile floor and a tiered chandelier that hung above what used to be his family dining room.

He was stuck on this uncomfortable hospital bed because he’d had the misfortune of being inside a North Philadelphia barbershop on an unseasonably warm January night at the same moment two men barged in, looking to rob the place.

Frazier, whose round face is framed by a scraggly beard and short dark hair, glanced at three children who happened to be in the shop. He was a father, with two kids at home, and felt an instinctive urge to protect them. He hurled himself at the would-be thieves. One had a handgun and fired two shots. The bullets punched through Frazier’s midsection and leg, ricocheting off his insides, tearing through tissue and bone before exiting his body.

At age 28, he was paralyzed from the waist down.

Frazier was a hero by anyone’s definition of the word, but he was also a victim, one of the estimated 116,255 people who are shot in the U.S. every year. He belongs to an often-overlooked fraternity of gun violence survivors who are left with lifelong disabilities, whose ranks include schoolchildren, movie-­theater patrons, politicians and grandmothers.

Several thousand miles from Philadelphia, Richard Castaldo, 37, sits in a wheelchair in Los Angeles, trapped in a pose he’s held since April 20, 1999, when he was shot eight times and paralyzed by his classmates Eric Harris and Dylan Klebold outside of the cafeteria at Columbine High School in Colorado. Harris and Klebold killed 13 people and wounded 21 others that spring morning, ushering in an age of relentless mass shootings in America.

In Philadelphia, where more than 1,250 people have been shot so far this year — up 15 percent over 2017 — survivors face an average of $46,632 in medical costs, according to the Department of Public Health.

But as Castaldo — and Frazier — found out, hospital bills are just a small portion of the financial burden that’s shouldered by survivors, no matter if they’re injured in a nationally prominent mass shooting or a spurt of inner-city violence that attracts only glancing media attention. Many struggle to navigate a confusing web of local, state and federal assistance programs, which are plagued by steep backlogs and in some cases can award as little as $1,500 to victims whose injuries require expensive lifelong care. Some, in their desperation, turn to Kickstarter or GoFundMe campaigns to help them obtain such basic needs as handicapped-accessible housing, transportation and even functional wheelchairs.

Castaldo has had visibility that victims of inner-city gun violence like Frazier could never dream of — he met former President Bill Clinton, and received a portion of the $6 million that donors gave to Columbine charities after the school massacre. But like so many gunshot victims, he still struggles to make ends meet, and almost lost his condominium in California to foreclosure in 2012. In December, he will finally move into a handicapped-accessible apartment that he and his mother have sought for years.

Frazier, meanwhile, has pined for freedoms that seem well beyond his family’s grasp, like a house large enough for him to move through in his wheelchair. Much of his energy has been spent on trying to keep his head above the waves of a depression that threatens to pull him down into the darkness.

“No other country has this level of gun violence, or the cost shifted to individuals for treatment of the wounds they suffered as a result of that gun violence,” said Kris Brown, co-president of the Brady Campaign. “It’s unconscionable.”

We are, at this point, well-versed in the art of responding to shootings that claim innocent lives. The initial shock gives way to hashtags, candlelit vigils and vows to never forget. Disabled survivors are a footnote in this ritual, their struggles largely unseen, except by people like James Schuster, a neurotrauma ­director at the Hospital of the University of Pennsylvania.

Trim, with a shock of white hair and the remnants of a South Dakota accent, Schuster focuses in particular on patients with spinal cord injuries. According to his records, HUP has handled at least 85 gunshot paralysis cases since 2012. But determining how many other people across Philadelphia have been shot and paralyzed in that time frame is, surprisingly, almost impossible. None of the city’s other top hospitals — Temple, Einstein, Jefferson and Hahnemann — were able to provide the Philadelphia Inquirer and Daily News with the number of gunshot paralysis cases they have had because they don’t specifically categorize or track this type of injury.

The National Spinal Cord Injury Statistical Center estimates as many as 45,000 Americans have been paralyzed from gunshot wounds.

“In a way,” Schuster said, “it’s almost a little bit of an orphaned subset.”

There could have been more extensive data on these victims today if things had played out differently in Washington in the mid-1990s. Around that time, the National Rifle Association began claiming the Centers for Disease Control and Prevention was producing “antigun propaganda” in the form of a study that examined firearm-related deaths. Congressional Republicans responded in 1996 by eliminating $2.6 million worth of funding that the agency used for its research related to gun violence.

Republican lawmakers also added the “Dickey Amendment,” named after then-Rep. Jay Dickey, into the CDC’s annual appropriations budget, which prohibited the agency from using any funding to advocate for gun control, bringing gun violence research to a near standstill. (Dickey, an Arkansas Republican, later admitted that he regretted the amendment and called for research to be renewed.)

Earlier this year, Sen. Bob Casey, D-Pa., and 33 other senators asked the Senate Appropriations Committee to set aside $50 million for the CDC to begin studying the causes of gun violence in America. “What a radical thing to do, right?” Casey said. “I would think there should be some way to gather data that would give you an approximation of how many people you’re talking about.”

His funding request was ignored by the Appropriations Committee.

In the meantime, clinical medical trials and research foundations tend to overlook gunshot paralysis victims because they have other medical complications from being shot. “It has to do with ballistics, with the transfer of energy,” Schuster explained. “Even if the bullet doesn’t actually go through the spinal cord or the spinal canal, there’s a blast effect, there’s a percussive effect. The injuries are much worse than they appear.”

Some of Schuster’s patients end up at Magee Rehabilitation Hospital, where Mary Schmidt, the spinal cord injury program director, prepares survivors and their families for the maladies that can arise from paralysis: bowel and bladder issues, pressure ulcers, urinary tract infections, chronic respiratory problems.

The spinal cord can’t regenerate, but many of Schmidt’s patients struggle to accept the permanence of their injury. “Every day, people come in here and say, ‘I don’t need to talk about that wheelchair, because I’m going to walk out of here,’” she said.

When survivors are ready to talk resources, they’re greeted with another harsh shock. If they don’t have family members at home who can help to take care of them, they can face being stuck in a nursing home. If they do have a place to stay, they have to grapple with a bureaucratic scavenger hunt for resources.

Medicaid, which congressional Republicans have targeted for steep cuts, will cover the cost of a wheelchair, Schmidt said, but would balk at replacing one if it breaks before a person is due to receive a new one. Assistive technologies, like voice-dictation systems for computers, can be life-changing for quadriplegics, “but no government system, no third-party payers — your Blue Crosses, your Aetnas — are buying that stuff, because it’s not medically necessary,” she said.

Funding for state and federal assistance programs, meanwhile, varies every year. Families often turn to GoFundMe pages to help fill the gap, but this, too, can be problematic; some recipients have found that donations are taxable.

“Disability awareness in general is definitely better than it used to be,” Schmidt said. “But is it easy for someone with a disability? No. And it’s never going to be for those people who are really intensely disabled.”

You have to go back 30 years to find a moment when gun violence had the power to shock the conscience of a city. On a sticky July afternoon in 1988, a shootout between rival drug gangs erupted at 20th and Tasker streets in South Philadelphia. One of the participants, a 21-year-old named Lonnie Summers, fired four shots at a passing car.

One of Summers’ bullets found an unintended target: 6-year-old Ralph Brooks Jr.

“I was running to my grandmom’s house,” Brooks would later tell a Common Pleas Court judge. “I got to my front door, and I fell down on my stomach, and I couldn’t feel anything.”

His sister found him lying in a pool of blood. “Breathe!” one neighbor screamed at the boy. “Breathe!”

Brooks had been shot in the spine, and was instantly paralyzed from the chest down. Heartsick residents who followed news coverage of the story donated thousands of dollars to an education fund for the sweet-faced little boy, whose recollection of the shooting brought the judge and prosecutor presiding over Summers’ trial to tears.

While Brooks remained a beloved figure in his neighborhood, where a playground was later named in his honor, his family struggled to meet his needs. His mother paid for a wheelchair ramp out of her own pocket, and relatives carried him in their arms from one floor of their house to another, until he became too big for them to lift.

“No one ever approached my family and informed us of various services that he was entitled to,” said Nashira Alston, one of Brooks’ sisters, a refrain that the Inquirer and Daily News found is commonly uttered by relatives of gunshot paralysis victims across the country.

“He would go through wheelchairs very fast,” she said. “And yet there was a rule that you could only get a new wheelchair every five or so years.”