(Not) Born in the USA

This post is by Macharia Edmonds, a summer intern with the Health Justice Program and a law student at Northwestern University School of Law in Chicago, IL.

Too often in this country, the treatment of those not born in America differs from those born within our borders.  Some New York hospitals have done the unthinkable and are discharging some non-citizen patients to their death.  These hospitals are practicing what is called medical deportation.  This occurs when a hospital discharges a severely injured, sometimes disabled, non-citizen patient who is in need of long term care to a medical facility in their home country.  Unfortunately these facilities are usually not equipped to adequately treat the patient’s medical needs and the patient often suffers considerable pain and sometimes death from this lack of treatment.

Under New York state law, a patient is required to sign off on a discharge plan which details any health care arrangements needed after the discharge.  These patients are sometimes incapacitated or can have a limited English proficiency which makes understanding the choices they are dealt with difficult if not impossible.  In situations where the patient does not speak English the hospital can and should provide an interpreter.  In situations where the patient may be incapacitated, things become more complex.  If the patient is not able to consent to a discharge then the hospital should look to either an appointed surrogate or a family member.  If there is no one from these groups available to decide, there is often confusion as to who has the right to make this decision.

The New York State Legislature has attempted to address this issue by introducing S7429 and A8647C, a bill that creates a three person panel which would be in charge of making these decisions in the absence of other family or appointed representatives.  This panel would presumably be able to protect patients from being denied adequate medical treatment.  This bill is well intentioned but has a number of issues.  Some of these issues include who is allowed to serve on this panel, the lack of information given to the patient and family during the decision making process, and the lack of restrictions and regulations on discharges to foreign medical facilities.  NYLPI has offered and will continue to offer to the Senate and Assembly suggestions for this bill so that it ensures these patients who are incapacitated and not able to advocate for themselves receive the proper medical care.  No matter what country you are a citizen of, simply being a human being should require a certain level of care.

Proton Beams or Primary Care

Crain’s Health Pulse, the New York health industry rag, has been abuzz for the last couple of weeks with news about health services in Queens.  Specifically, there’s been a lot of talk about a proposed “proton beam cancer center” to be located on the former site of Mary Immaculate Hospital (“MIH”), and to be funded by “500 rich foreigners” (for real).  Readers of this blog will recall that we have been collaborating with a community-based coalition, Southeast Queens United in Support of Healthcare (SQUISH), for several years, first working with coalition members to keep MIH from shutting down and now partnering with them to advocate for health services to fill the void created by the hospital’s closure.  The question is: does a proton beam cancer center fill that void, even in part?

And the truth is we’re not really sure.  On the one hand, cancer is one of the leading causes of death in Jamaica, Queens, resulting in 3,636 potential years of life lost in the area according to the NYC Department of Health.  Proton beam therapy is basically a way to offer cancer radiation treatment that is more targeted and less likely to impact healthy tissue surrounding the cancerous cells.  Considering these facts, a proton beam cancer center would seem to be a good thing because it offers cutting-edge treatment for a disease that kills a lot of people in Southeast Queens.

On the other hand, no one knows if the proposed cancer center would actually be affordable or accessible to most of the residents of Southeast Queens.  Will it accept public health insurance plans like Medicare and Medicaid?  Will it have sliding fee scales for the uninsured and under-insured?  If not, then the proton beam cancer center will hardly fill the enormous gaps in health access that plague the neighborhoods of Southeast Queens, and will serve instead as a lily pad for rich foreigners who can hop in and out of Queens for their high-end treatment from nearby JFK airport.  Viewed from this perspective, the proton beam cancer center isn’t worth celebrating; what is needed is more primary care and hospital beds.  Indeed, just recently, Crain’s also reported that the intensive care units of hospitals in Queens are themselves in a state of acute stress — over-capacity by over 200% in some cases.

There is no doubt that the Southeast Queens community needs more health services.  As we’ve written before, in New York City and in other major metropolitan areas across the country there is a close relationship race, place and access to healthcare services, and Southeast Queens is a prime example of the mis-match between healthcare need and resources.  In the wake of MIH’s closure, it is unclear whether wave-of-the-future technology like proton beam cancer therapy is really what the doctor ordered, or if it would simply be better to have some old school primary and preventative care services that would help people avoid getting gravely ill in the first place.  In an effort to better understand the implications of the center on their community, members of SQUISH are considering reaching out to the State Department of Health to find out more about the proposal and make their concerns known.  We will keep you apprised of any developments, but, in the meantime, don’t be shy!  Let us know through your comments here if you live in Southeast Queens and have any opinions on the matter.  We look forward to hearing from you.