Monday, August 04, 2008

IHT article on US hospitals forcibly repatriating undocumented persons

The International Herald Tribune has an article that goes into more detail on the issue I raised earlier on undocumented immigrants being forcibly repatriated by hospitals acting vigilante style.

(To clarify, the hospitals are certainly doing the repatriations as humanely as possible. However, the hospital in this article acted of its own accord, qualifying this as a vigilante action.)

The person featured in this article, Luis Alberto Jiménez, is the same person who was featured in the NY Times video I linked.

Many hospitals engage in repatriations of seriously injured and ill immigrants only as a last resort. "We've done flights to Lithuania, Poland, Honduras, Guatemala and Mexico," said Cara Pacione, director of social work at Mount Sinai Hospital in Chicago. "But out of about a dozen cases a year, we probably fly only a couple back."

Other hospitals are more aggressive, routinely sending uninsured immigrants, both legal and illegal, back to their homelands. One Tucson hospital even tried to fly a U.S. citizen, a sick baby whose parents were illegal immigrants, to Mexico last year; the police, summoned by a lawyer to the airport, blocked the flight.

Sister Margaret McBride, vice president for mission services at St. Joseph's in Phoenix, which is part of Catholic Healthcare West, said families were rarely happy about the hospital's decision to repatriate their relatives. But, she added, "we don't require consent from the family."

In a case this spring that outraged Phoenix's Hispanic community, St. Joseph's planned to send a comatose, uninsured legal immigrant back to Honduras, until community leaders got lawyers involved. While they were negotiating with the hospital, the patient, Sonia del Cid Iscoa, 34, who has been in the United States for half her life and has seven American-born children, emerged from her coma. She is back in her Phoenix home.

"I can think of three different scenarios that would have led to a fatal outcome if they had moved her," said John Curtin, her lawyer. "The good outcome today is due to the treatment that the hospital provided - reluctantly, and, sadly enough, only in response to legal and public pressure."

Unlike Iscoa and Jiménez, most uninsured immigrant patients in repatriation cases do not have advocates fighting for them, and they are quietly returned to their home countries. Sometimes, their families accept that outcome because they are told they have no options; sometimes they are grateful to the hospital for paying their fare home, given that other hospitals leave it to relatives or consulates to assume responsibility for the patients.

Jiménez's case is apparently the first to test the legality of cross-border patient transfers that are undertaken without the consent of the patients or their guardians - and the liability of the hospitals who undertake them.

"We're the rhesus monkey on this issue," said Scott Samples, a spokesman for Martin Memorial.


Jiménez was an expensive charity case. In cases like his, where patients need long-term care, hospitals are not allowed to discharge them to the streets. U.S. regulations require them - if they receive Medicare payments, and most hospitals do - to transfer or refer patients to "appropriate" care.

But in most states, the government does not finance post-hospital care for illegal immigrants, for temporary legal immigrants or for legal residents with less than five years in the United States.

Martin Memorial's lawyer, Robert Lord Jr., said hospitals should not be forced to assume financial and legal responsibility for these cases. "It should be a governmental burden," he said, "or the government should step in and otherwise exercise its authority for deportation or whatever it wants to do."

In Jimenez's case, the hospital's doctors determined that appropriate post-hospital care meant traumatic brain injury rehabilitation.

Hospital discharge planners searched to no avail for a rehabilitation program or nursing home.

Representing Jiménez's guardian, Michael Banks, a local lawyer, took the position that the hospital had a responsibility to provide Jiménez with the rehabilitation he needed, even if that meant paying a rehabilitation center to provide it. That, he noted, could have benefited both the hospital and the patient.

But the hospital declined, as Lord put it, "to take out our checkbook" and subsidize Jimenez's care at another institution.

"Once you take that step, for how long are you going to do that - a year, 10 years, 50 years?" asked Lord, the hospital lawyer.

Eventually, the Guatemalan health minister wrote a letter assuring Martin Memorial that his country was prepared to care for Jimenez.

Gabriel Orellana, who was foreign minister at the time but did not have direct knowledge of the case, said the Guatemalan government was disposed to assist an American institution. "If a hospital in Florida asks if we can take care of a Guatemalan patient, the tendency is to say yes," Orellana said.

With the guardian and the hospital at an impasse, Martin Memorial took the matter to court, asking a state judge to compel relatives to cooperate with its repatriation plan.

In court, Jiménez's doctor, Walter Gil, testified that Jiménez would benefit from returning to the intimacy of his family.

Dr. Miguel Garces, a prominent Guatemalan physician and public health advocate, said in a deposition that serious rehabilitation was "almost nonexistent" in Guatemala outside private facilities. He predicted that Jiménez would be taken in and then released from the country's one public rehabilitation hospital within a matter of weeks.

The judge granted the hospital's petition. Banks, the guardian, requested a stay, but the hospital sent Jiménez back to Guatemala just hours before its response to the stay request was due.

An appeals court later found that the Florida state judge had overstepped his bounds because deportation is the prerogative of the U.S. government. The court also declared that no evidence supported the hospital's assertion that Jiménez would receive appropriate care in Guatemala; the discharge plan, the ruling said, had not been detailed enough to satisfy federal requirements or the hospital's own rules.

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