Monthly Archives: July 2009

International Patient Dumping

A little before 1am on December 1, 1985, a pregnant woman who was about to give birth was taken by a friend to a hospital in San Pablo, California. Upon arrival, hospital staff refused to admit the woman because the hospital did not accept her insurance plan. The woman was told to go to another hospital in Oakland instead. Approximately three hours later, the woman arrived at the second hospital, where doctors detected an irregular heartbeat in the fetus. Nevertheless, the woman was once again denied service because hospital staff could not find any record of the woman being enrolled in an insurance plan. She was eventually taken to the local county hospital, which accepted patients regardless of their insurance status. By the time the woman arrived at the county hospital, however, the fetus had a barely detectable heartbeat. At 4:26am, the woman’s baby was pronounced dead. This outcome could have been avoided if the two hospitals she went to first did not refuse to treat her.

In 1986, in response to dramatic news accounts of cases such as the one described above, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA). The purpose of EMTALA was to “send a clear signal to the hospital community, public and private alike, that all Americans, regardless of wealth or status, should know that a hospital will provide what services it can when they are truly in physical distress.” The purpose was, in other words, to prevent the practice of “patient dumping.”

These days, patient dumping continues, and it has gone international. In a process known as “medical deportation,” uninsured patients, generally undocumented immigrants, in need of tertiary or long-term care are transferred by private hospitals back to their home countries, where they are not guaranteed a sufficient level of health care to survive. It is tempting to think–and it is often suggested–that medical deportation is a new, thorny, perhaps intractable problem in health care policy arising out of the growth in the undocumented immigrant population in the United States. However, we see it as just another iteration of how health care services are often denied to low-income communities of color unless adequate protections are put in place. Earlier forms of patient dumping tended to disproportionately impact low-income, African-American patients living in major urban areas. Meanwhile, medical deportation disproportionately impacts low-income immigrant communities, including those living in major urban areas like New York City. Both offer rather breathtaking examples of how financial and bureaucratic imperatives cause health care providers to forget that they work in the service and support of human life.

This past week, we co-hosted, along with the New York Immigration Coalition and the New York Academy of Medicine, a meeting of health, immigrant, and disability rights advocates from across New York State to start strategizing about ways to address the problem of medical deportation in the short- and long-term. The meeting was very well attended–approximately 40 people participated–and it covered a lot of ground, but one message came through clearly: that there is an urgent need to, once again,” send a clear signal to the hospital community… that all Americans, regardless of wealth or [immigration] status, should know that a hospital will provide what services it can when they are truly in physical distress.”

We will keep you as the work of the medical deportation workgroup progresses.

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Let’s Talk About Race, Baby

Just learned that, this morning, Bronx Health REACH piloted our Provider Discussion Guide with a group of high school and college students affiliated with the AHEC program, which is focused on increasing the diversity of the medical profession.  And it was a huge success!  The guide, along with the CNN piece, stimulated thought-provoking conversation about racial inequities in health care and is an indication that it is possible to have productive dialogue about race if we are thoughtful and deliberate about how we do it.   Apparently others are also having success with positive and productive race talk.

We’ll be piloting the Community Discussion Guide at the next meeting of Bronx Health REACH faith-based coalition.  Stay tuned for a report on how that goes.

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CNN News Story: Medical Care Double Standard?

Last night, CNN featured our campaign with Bronx Health REACH on separate and unequal care in New York City academic medical centers.  You can view it here.

It is unusual for mainstream media to tackle problems such as institutional racism in the health care system, and for that reason alone it was exciting for our campaign to get the kind of exposure that it did last night.  This was not merely a situation of “any press is good press,” either.  From our point of view, CNN’s coverage was sensitive, thoughtful and true to what we have heard in the community when the cameras are not running.

But the reaction to the story outside our community–outside the Bronx, outside the civil rights & racial justice community–has been far less approving.  The general tenor of the commentary by the CNN viewing public is that blacks should stop complaining because whites get bad care too.  This is tragic because it is partly true.  White people absolutely do get bad care within the American health care system, particularly if they are not wealthy or are uninsured.  In fact, one of the claims in our case is based on a federal law that, among other things, makes it unlawful for hospitals to discriminate against patients because they are on public health insurance.

However, it does not follow from this that blacks and Latinos should stop complaining about the inferior care that they systematically receive within the system.  No, the truth is we should all be complaining loudly and constantly about the failures of the existing health care system.  People of color are disproportionately and profoundly more likely to get the short end of the health care stick, and so we should be raising our voices and demanding change with all the energy we can muster.  But all of those white people who wrote on CNN’s blog, sharing their personal stories of pain within the health care system, should speak out too — not in opposition, but in solidarity.  Otherwise, the whirling maelstrom that is the American health care system will sink all our boats.

For a similar view, please check out this post by Dr. Neil Calman, one of the founders of Bronx Health REACH and the physician featured in the CNN news story.

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CNN features Bronx Community’s Civil Rights Campaign

For the past two years, we have been representing a community coalition in the Bronx in a case about insurance- and race-based segregation in New York City hospitals.  This Monday night, our campaign is going to be featured in an investigative news piece by Dr. Sanjay Gupta on CNN!  The piece will air during the Anderson Cooper 360, between 10pm and midnight; not sure yet which hour.  Please tune in and show your support!  (Or for those of you with more new-fangled technology, be sure to DVR it.)

Better yet, tune in with a group and use the story as an opportunity to talk about institutional racism in the health care system, and what can be done about it.  Check out our Community Discussion Guide to help you facilitate the conversation.  If you’re a health care provider, you get your own Provider Discussion Guide.

And please spread the word.  There’s been a lot of talk about the health reform proposals coming out of Washington these days.  Well, we’re offering a plan rooted in community activism, South Bronx style.

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