Hundreds of immigrants have been deported not by the federal government but by hospitals looking to cut costs by getting rid of undocumented patients in need of long-term care.
In a process known as “medical repatriation”, US hospitals send undocumented patients back to their home countries, often while they’re comatose and unable to consent. The hospital typically pays for the flight, but that’s it.
In a report released in December of last year, the Center for Social Justice (CSJ) counted the involuntary removal of 800 immigrant patients from hospitals in 15 states to at least seven different countries including El Salvador, Guatemala, Honduras, Lithuania, Mexico, Philippines, and South Korea, though this doesn’t take into account deportations that go unreported. A recent article by the Associated Press reports 600 immigrant patients medically repatriated in the last five years alone.
According to the CSJ, hospitals are legally obligated to provide emergency medical treatments to all patients regardless of ability to pay or citizenship status. But that requirement ends once the patient is stable.
At this point, federal law requires hospitals to create a discharge plan and transfer patients to “appropriate facilities” that ensure the health and safety of the patient. Unfortunately, many long-term care facilities, rehabilitation centers, and nursing homes are reticent to accept immigrant patients because many are ineligible for public health insurance due to their immigration status and cannot otherwise afford private health insurance.
This combination of vulnerable immigrant patients and lack of a reimbursement stream for their care has contributed to a situation in which many hospitals take matters into their own hands. Acting alone or in concert with private transportation companies, such hospitals are functioning as unauthorized immigration officers and deporting seriously ill or injured immigrant patients directly from their hospital beds to their native countries. Such hospitals are engaging in de facto deportations either without the consent of the immigrant patient or by exercising coercion to obtain consent.
Furthermore, the undocumented patients are often sent to medical facilities in their home countries that are ill-equipped to provide them with the necessary care. Consequences range from long-term disability to death.
The CSJ is concerned that these under-the-radar, illegal deportations will increase with the 2014 implementation of the Affordable Care Act, which expands Medicaid eligibility to millions of previously uninsured Americans while also decreasing funding to hospitals that provide care for the uninsured. But undocumented immigrants are not eligible for Medicaid. The fear is that hospitals that typically treat uninsured immigrants will turn to medical repatriation to make up for the decrease in funding.
But the Associated Press came out with an article today that details the medical repatriation of two Iowa immigrants, Jacinto Cruz and Jose Rodriguez-Saldana, despite having had health insurance through their employer
The men were seriously injured in a car accident in 2008. Though their insurance had already paid over $100,000 for emergency treatment, Iowa Methodist was unsure whether their policy would cover long-term rehabilitation and two rehabilitation centers refused to take them. So just 11 days after the accident, the hospital put the still unconscious men on a plane to Mexico.
Rodriguez-Saldana told the AP that Hospital officials falsely told his family that he was being sent home because he was likely going to die. Apparently, this is a typical scheme:
Patients are frequently told family members want them to come home. In cases where the patient is unconscious or can’t communicate, relatives are told their loved one wants to return, De Leon said.
Sometimes they’re told the situation is dire, and the patient may die, prompting many grief-stricken relatives to agree to a transfer, he said.
Some hospitals “emotionally extort family members in their home country,” De Leon said. “They make family members back home feel guilty so they can simply put them on a plane and drop them off at the airport.”
Both men continue to suffer debilitating medical problems, which they blame on Iowa Methodist for sending them to an inadequate facility:
Nearly five years later, the 49-year-old Cruz is paralyzed on his left side, the result of damage to his hip and spine. He has difficulty speaking and can’t work.
“I can’t even walk,” he said in a telephone interview, breaking into tears several times. His long-term partner, Belem, said he’s more emotional since the accident.
“He feels bad because he went over there and came back like this,” she said. “Now he can’t work at all. … He cries a lot.”
She works selling food and cleaning houses. Their oldest son, 22, sometimes contributes to the family income.
Rodriguez-Saldana said he has to pay for intensive therapy for his swollen feet and bad circulation. He also said he walks poorly and has difficulty working. He sells home supplies such as kitchen and bath towels and dishes, a business that requires a lot of walking and visiting houses. He often forgets where he lives, but people recognize him on the street and take him home because he’s confused.
The men sued the hospital in 2010, but:
A judge dismissed the lawsuit last year ruling that Iowa Methodist was not to blame for the inadequate care in Veracruz. The courts also found that even though the families of the men may not have consented to their transport to Mexico, they also failed to object to it. An appeals court upheld the dismissal.
In a separate article, the AP provides details about three of the most heart-breaking, dramatic cases of medical repatriation, which you can see here.