April 23, 2013

U.S. hospitals send hundreds of immigrants back home

The system, called "medical repatriation," allows hospitals to put patients on chartered international flights, often while they are still unconscious.

The Associated Press

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Jacinto Rodriguez Cruz, 49, leaves his home in a wheelchair with the help of his wife, Belen Hernandez, in Veracruz, Mexico, recently. Cruz and another friend suffered serious injuries during a car accident in May 2008 in northwestern Iowa. After their employers' insurance coverage ran out, Cruz, who was not a legal citizen, was placed on a private airplane and flown to Mexico still comatose and unable to discuss his care or voice his protest.

AP

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In this Wednesday March 6, 2013 photo, Jose Guadalupe Rodriguez-Saldana, 38, walks with orthopedic supports outside of his home in the town of Tierra Blanca, Veracruz state, Mexico. Rodriguez-Saldana and another friend suffered serious injuries during a car accident last May 2008 in northwestern Iowa. After their employers insurance coverage ran out, Rodriguez-Saldana, who was not a legal citizen, was placed on a private airplane and flown to Mexico still comatose and unable to discuss his care or voice his protest. Hospitals confronted with absorbing the cost of caring for uninsured seriously injured immigrants are quietly deporting them, often unconscious and unable to protest, back to their home countries. (AP Photo/Felix Marquez)

There's no way to know for sure whether the two men would have recovered faster or better in the United States. But the accident left both of them with life-altering disabilities.

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 American Hospital Association said it does not have a specific policy governing immigrant removals, and it does not track how many hospitals encounter the issue.

Nessel expects medical removals to increase with implementation of health care reform, which makes many more patients eligible for Medicaid. As a result, the government plans to cut payments to hospitals that care for the uninsured.

Some hospitals call immigration authorities when they receive patients without immigration documentation, but the government rarely responds, Nessel said. Taking custody of the patient would also require the government to assume financial responsibility for care.

Jan Stipe runs the Iowa Methodist department that finds hospitals in patients' native countries that are willing to take them. The hospital's goal, she said, is to "get patients back to where their support systems are, their loved ones who will provide the care and the concern that each patient needs."

The American Medical Association's Council on Ethical and Judicial Affairs issued a strongly worded directive to doctors in 2009, urging them not to "allow hospital administrators to use their significant power and the current lack of regulations" to send patients to other countries.

Doctors cannot expect hospitals to provide costly uncompensated care to patients indefinitely, the statement said. "But neither should physicians allow hospitals to arbitrarily determine the fate of an uninsured noncitizen immigrant patient."

Arturo Morales, a Monterrey, Mexico, lawyer who helps Cruz and Rodriguez-Saldana with legal issues, is convinced the men would have been better off staying in Iowa.

"I have no doubt," he said. "You have a patient who doesn't have money to pay you. You can't let them die."

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