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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