U.S. Hospitals Quietly Deport Hundreds Of Undocumented Immigrants
By DAVID PITT, 04/23/13 04:49 PM ET EDT - AP
DES MOINES, Iowa -- Days after they were badly hurt in a car accident,
Jacinto Cruz and Jose Rodriguez-Saldana lay unconscious in an Iowa hospital
while the American health care system weighed what to do with the two immigrants
from Mexico.
The men had health insurance from jobs at one of the nation's largest pork
producers. But neither had legal permission to live in the U.S., nor was it
clear whether their insurance would pay for the long-term rehabilitation they
needed.
So Iowa Methodist Medical Center in Des Moines took matters into its own
hands: After consulting with the patients' families, it quietly loaded the two
comatose men onto a private jet that flew them back to Mexico, effectively
deporting them without consulting any court or federal agency.
When the men awoke, they were more than 1,800 miles away in a hospital in
Veracruz, on the Mexican Gulf Coast.
Hundreds of immigrants who are in the U.S. illegally have taken similar
journeys through a little-known removal system run not by the federal government
trying to enforce laws but by hospitals seeking to curb high costs. A recent
report compiled by immigrant advocacy groups made a rare attempt to determine
how many people are sent home, concluding that at least 600 immigrants were
removed over a five-year period, though there were likely many more.
In interviews with immigrants, their families, attorneys and advocates, The
Associated Press reviewed the obscure process known formally as "medical
repatriation," which allows hospitals to put patients on chartered international
flights, often while they are still unconscious. Hospitals typically pay for the
flights.
"The problem is it's all taking place in this unregulated sort of a black
hole ... and there is no tracking," said law professor Lori Nessel, director of
the Center for Social Justice at Seton Hall Law School, which offers free legal
representation to immigrants.
Now advocates for immigrants are concerned that hospitals could soon begin
expanding the practice after full implementation of federal health care reform,
which will make deep cuts to the payments hospitals receive for taking care of
the uninsured.
Health care executives say they are caught between a requirement to accept
all patients and a political battle over immigration.
"It really is a Catch-22 for us," said Dr. Mark Purtle, vice president of
Medical Affairs for Iowa Health System, which includes Iowa Methodist Medical
Center. "This is the area that the federal government, the state, everybody says
we're not paying for the undocumented."
Hospitals are legally mandated to care for all patients who need emergency
treatment, regardless of citizenship status or ability to pay. But once a
patient is stabilized, that funding ceases, along with the requirement to
provide care. Many immigrant workers without citizenship are ineligible for
Medicaid, the government's insurance program for the poor and elderly.
That's why hospitals often try to send those patients to rehabilitation
centers and nursing homes back in their home countries.
Civil rights groups say the practice violates U.S. and international laws and
unfairly targets one of the nation's most defenseless populations.
"They don't have advocates, and they don't have people who will speak on
their behalf," said Miami attorney John De Leon, who has been arguing such cases
for a decade.
Estimating the number of cases is difficult since no government agency or
organization keeps track.
The Center for Social Justice and New York Lawyers for the Public Interest
have documented at least 600 immigrants who were involuntarily removed in the
past five years for medical reasons. The figure is based on data from hospitals,
humanitarian organizations, news reports and immigrant advocates who cited
specific cases. But the actual number is believed to be significantly higher
because many more cases almost certainly go unreported.
Some patients who were sent home subsequently died in hospitals that weren't
equipped to meet their needs. Others suffered lingering medical problems because
they never received adequate rehabilitation, the report said.
Gail Montenegro, a spokeswoman for U.S. Immigration and Customs Enforcement,
said the agency "plays no role in a health care provider's private transfer of a
patient to his or her country of origin."
Such transfers "are not the result of federal authority or action," she said
in an email, nor are they considered "removals, deportations or voluntary
departures" as defined by the Immigration and Nationality Act.
The two Mexican workers in Iowa came to the U.S. in search of better jobs and
found work at Iowa Select Farms, which provided them with medical insurance even
though they had no visas or other immigration documents.
An Iowa Select Farms spokeswoman said Tuesday she could find no record that
the men worked for the company under those names. The attorney for the two men
said he learned through subpoenas that they had worked for a pork company that
he believes was once a subsidiary of Iowa Select.
The two were returning home from a fishing trip in May 2008 when their car
was struck by a semitrailer truck. Both were thrown from the vehicle and
suffered serious head injuries.
At the time, Cruz had been here for about six months, Rodriguez-Saldana for a
little over a year.
Insurance paid more than $100,000 for the two men's emergency treatment. But
it was unclear whether the policies would pay for long-term rehabilitation. Two
rehabilitation centers refused to take them.
Eleven days after the car crash, the two men were still comatose as they were
carried aboard a jet bound for Veracruz, where a hospital had agreed to take
them.
Rodriguez-Saldana, now 39, said the Des Moines hospital told his family that
he was unlikely to survive and should be sent home.
The hospital "doesn't really want Mexicans," he said in a telephone interview
with the AP. "They wanted to disconnect me so I could die. They said I couldn't
survive, that I wouldn't live."
Hospital officials said they could not discuss the case because of
litigation. The men and their families filed a lawsuit in 2010 claiming they
received minimal rehabilitative care in Veracruz.
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.
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."
In court documents, Iowa hospital officials said they had received permission
from Saldana's parents and Cruz's long-term partner for the flight to Mexico.
Family members deny they gave consent.
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."
___
Associated Press Writer Barbara Rodriguez in Des Moines contributed to this
report.