It’s 2:00 A.M. at a small airport in Arizona as an ambulance pulls up to a small plane on the runway, several people hop out of the ambulance, unload a man in a stretcher and carry him onto the plane. They return to their ambulance and drive off into the night, leaving the few onlookers to wonder what happened. What they don’t know is that the man on the stretcher is an uninsured immigrant who has suffered devastating injuries on American soil. As his hospitals bills pile up and he is unable to pay them, the hospital makes the decision to deport him back to his native country. Although the man is promised health care upon his arrival, the care will not be nearly adequate for his condition. His trip home is a death sentence.
A number of recent reports have shed light on the issue of immigrant deportation by U.S. hospitals. In August of 2008, a New York Times article outlined the story of Luis Jiménez, a Guatemalan illegal immigrant who “has come to represent the collision of two deeply flawed American systems, immigration and healthcare” [1]. Jiménez was severely injured when a drunk driver in Florida hit him on February 28, 2000; he now has the brain activity of a fourth grader. A local community hospital, Martin Memorial, saved his life and subsequently kept him as a patient for a few years at a cost of $1.5 million, since they were unable to find a rehabilitation center that was willing to accept an uninsured patient in his condition [1]. Jiménez was then deported to Guatemala – not by the federal government, but by Martin Memorial, due to the cost of his care.
Or take the case of Pedro Guzman, a mentally ill man who was jailed for a misdemeanor, a trespassing violation, and then sent to Mexico [3]. His panic-stricken mother is now searching the streets of Tijuana to try to find her son, who is vulnerable and easily disoriented. Guzman’s case is striking not only because his mental illness was overlooked in his repatriation, but also because his U.S. citizenship was overlooked as well. No mental hospitals would accept him due to lack of insurance, and he was deported even though he was a U.S. citizen.
A little known fact that has only recently been addressed is that many American hospitals, particularly those in states bordering Mexico, are taking it upon themselves to repatriate seriously injured or ill immigrants without insurance. They are doing this because it is next to impossible to find post-hospice care centers that will accept these patients. Hospitals do this without the assistance or oversight of the federal government, leaving room for legal and ethical transgressions on both sides of the border [1].
In the U.S., hospitals are choosing which patients they will provide care for. Consequently, their actions imply that healthcare is not be standardized for everyone; rather, it is allocated to those who have the money to pay for it. In Mexico, there is the possibility that an ill citizen will be ignored upon his return to his home country. There are not nearly as many facilities capable of providing adequate care in Mexico as there are in the U.S.; if someone is refused treatment in the U.S., there is a strong chance that he will not be able to access treatment in Mexico either.
Hospital administrators view cases such as that of Mr. Jiménez’s as costly patient transfers that “force them to shoulder responsibility for the dysfunctional immigration and health-care systems” [1]. In the U.S., hospitals are mandated to treat anyone suffering from an emergency medical condition, and the federal government provides Medicaid insurance in emergencies for illegal and new immigrants. However, hospitals are encountering issues because this coverage only pays a tiny portion of the true expenses. Moreover, federal regulations require hospitals that accept Medicaid payments (most do) to transfer patients to “appropriate” post-hospice care [1]. But the government doesn’t finance this care for illegal immigrants, temporary legal immigrants, or legal residents with less than five years in the U.S. (except California and New York City). Because of this, hospitals argue that the cost of caring for patients like Mr. Jiménez should be a governmental concern, rather than a burden that falls on the hospital. Hospitals worry they won’t have the funds to care for American citizens if they provide thousands of dollars of care to uninsured (and sometimes illegal) immigrants. Alan B. Kelly, vice president of Scottsdale Healthcare in Arizona, points out, “What it does for us, it puts a strain on our system, where we’re unable to provide adequate care for our own citizens” [1].
It’s no secret that immigrants have less access to health care than U.S.-born individuals. Higher per capita emergency department expenditures for immigrant children than for U.S.-born children suggests that access to routine care is particularly problematic for immigrant children [3]. Many immigrants do not attempt to get healthcare until it becomes an emergency for fear of deportation. Since immigrant children will become a major segment of the U.S. workforce in the future, ensuring their access to healthcare is needed for proper growth and development [3].
It certainly seems wrong for a person to fear seeking treatment for an urgent health issues because they are afraid the hostpial will deport them. On the other hand, taking of case of Mr. Jiménez as an example, the hospital did not refuse emergency treatment. It was after he had basically become a boarder at the hospital that Martin Memorial began to feel the impact of the financial burden he was causing them. Hospitals worry that the money used to support an uninsured illegal immigrant whose chances of complete recovery are close to zero can be used to save an American citizen who might have a better chance at a full recovery. The ethical questions faced by hospital administrators in these situations are immense. While it is easy to chastise hospitals such as Martin Memorial for their actions, it’s necessary to see each case through the hospital’s eyes before making a judgment about their decisions.
In the case of Mr. Jimenez, the Florida Fourth District Court of Appeal ultimately decided that it was wrong of Martin Memorial to deport him. The court felt that the hospital’s assertion that Jiménez would receive appropriate post-hospice care in Guatemala wasn’t affirmed by enough evidence, and that his care in Guatemala would be extremely inadequate for his needs [1]. Their decision came too late for Jiménez, who was already in Guatemala by then, but hopefully it has set a precedent for people like him to receive appropriate care in the future when necessary. It is difficult enough to give care to everyone who needs it in America; many American citizens themselves are uninsured and lack access to health care. But in drastic cases when someone is seriously injured on American soil and will not receive the necessary medical care anywhere else, isn’t it necessary to provide that care despite one’s legal status? Which is more important – human life or the legal complications of social identity?
- Sontag. Deborah, “Immigrants Facing Deportation by U.S. Hospitals,” New York Times (2 August 2008): A1
- Lawsuit filed over man deported and lost in Mexico,” Reuters (27 Feb 2008) <http://www.reuters.com/article/domesticNews/idUSN2747919120080227>
- Mohanty, S.A. et al, “Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis,” American Journal of Public Health (August 2005): Vol 95, No. 8
- Picture Credit: http://frontpage.americandaughter.com/images/pantaleon-protest.png
Tags: Guatemala, health insurance, healthcare, Mexico, United States
