Could deportation be a consequence for an unpaid hospitalbill? It was for Quelino Ojeda Jimenez, a young day laborer who, up until thispast February, had been receiving long-term care at the AdvocateChrist MedicalCenter in Chicago. Mr. Ojeda was admitted to thehospital in October of 2010, in critical condition after falling off a roof atwork. After being stabilized by the hospital medical team, he continued torequire long-term care.
But since Mr. Ojeda is an undocumented immigrant withno insurance, a limited social network in the US, and no access to privatelong-term care facilities, no one was able to pay the bill. Advocate Christ wasstuck – they could either continue to provide costly, daily medical care forMr. Ojeda for an indeterminate amount of time, or they could arrange for histransfer to a facility that would care for him in his home country. Theadministrators at Advocate Christ opted for the latter.
Mr. Ojeda’s case is hardly unique. Each year there are 100 similar cases ofmedical repatriations. To discharge the patient, hospitals typically hire acompany that specializes in international medical transfers, for a lump sum ofapproximately $60,000 per patient. Before the repatriation can take place, thecompany has the patient sign a form indicating their consent to the transfer.The hospital must also go through the discharge process and a physician mustauthorize the transfer.
Unfortunately, in most cases it is not simply atransfer from one facility to another of equal quality. Patients typically aremoved to resource-poor settings where they receive significantly decreasedquality of care and negative health outcomes. When Mr. Ojeda returned toMexico, his nurses were reusing old filters in his ventilator due to theirlimited availability and high cost. Even if Mr. Ojeda himself had consented tothe transfer, the harm caused to his health by the change in care qualityraises serious ethical questions.
What can be done to begin to address this issue? Hospitalsare suffering from real financial challenges, immigrant patients have limitedresources, and many physicians are paralyzed by this “dual loyalty” dilemma:should they approve transfers because their employer cannot afford to continueproviding care, or should they insist on the best care possible for theirpatients even if it bankrupts the hospital?
To date desperate hospitals have quietly carried out thesetransfers, and while they effectively operate as deportations, US Citizenshipand Immigration Services has failed to oversee or govern the process as itshould.
Since this is a complex issue involving multiple government agencies,private actors, and the entire health care industry, solutions will be hard tofind. But systems need to be developed that will preserve human rights for immigrantpatients in long-term hospital care while allowing hospitals to do what isnecessary to remain solvent. At aminimum, guidelines and proper oversight of the process of medicalrepatriations process must be introduced immediately.
To learn more about this issue and find out how you can getinvolved, visit the related webpage by New York Lawyers for the PublicInterest.