Deportation Dilemmas Deepen For U.S. Hospitals
By Jennifer Ludden
The NPR News, July 31, 2009
In a widely watched case in Florida this week, a jury ruled that a hospital acted 'reasonably' when it sent an undocumented immigrant who had no health insurance back to his native Guatemala. The case highlights a rare but growing problem, and it could affect how hospitals treat such patients in the future.
The case stemmed from a patient admitted to Martin Memorial Medical Center, in South Florida. In 2003, the hospital faced a dilemma: For three years, it had been caring for day laborer Luis Jimenez, who'd been hit by a drunk driver and left a paraplegic with brain damage. The hospital had spent $1.5 million treating him. Now it wanted to transfer him to a cheaper, long-term care facility.
Carla Luggiero of the American Hospital Association says hospitals face limited options for patients with no insurance and no legal status.
'We could help find a charity bed, or subsidize them at a nursing home, or send them home to relatives,' Luggiero says. 'Or we could keep them indefinitely. And in that case, that patient is utilizing a bed that could be used for someone who has a more acute health care need.'
When no other facility would take Jimenez, Martin Memorial turned to another option. Early one morning, against the wishes of Jimenez's cousin and legal guardian, the hospital chartered a plane for $30,000 and flew Jimenez to Guatemala. The government there had said it would care for him in a hospital. But he was soon discharged, and now lives with his mother, bed-bound, in a remote mountain-top village.
'He has no medical care there to speak of, and he's having an increasing number of seizures and increasing in intensity,' says Bill King, the lawyer for Jimenez's guardian.
Jimenez's family had sought damages, plus $1 million to cover the lifetime cost of his care in Guatemala. The Florida jury rejected that claim.
Luggiero says the case might make hospitals more comfortable transferring patients to their home countries, something she estimates happens once or twice a month. But others believe the high-profile case will have a different impact.
'What it is mostly likely to do for a lot of hospitals and a lot of patients is have a chilling effect on the front end,' says Larry Gage, who heads the National Association of Public Hospitals and Health Systems.
Gage says publicly funded hospitals by law must stabilize someone in crisis. That doesn't always mean admitting them.
'Hospitals may well try to define in as limited a way as possible their obligations to the patient [who] shows up at the emergency room,' Gage continues. 'And I think you'll see hospitals tightening up on their policies to try to mirror the reality of what they're going to get paid to do.'
There's another aspect to the case: A state judge originally approved Jimenez's repatriation. But an appeals court later overturned that. It said state judges have no power to decide immigration cases. It was too late for Jimenez, but lawyer Bill King hopes that the ruling sends a message to hospitals.
'You can't just decide to remove a foreign national, an undocumented person, and send them into what we contend, of course, was a medical abyss,' King says. He plans to appeal the jury decision denying damages to Luis Jimenez's family.
In a statement, Martin Memorial Medical Hospital said the most disappointing part of this case is that the issue of providing health care for undocumented immigrants remains unresolved. Unfortunately, the hospital says, none of the health care overhauls being debated in Congress would address it.