Medical Repatriation: Hospitals Deporting Sick Patients

by Christine Chiu, Staff Attorney

Everyone knows to go to the emergency room in a medical crisis. We believe that the doctors there will take care of us and get us the treatment that we need. The emergency room doesn’t turn anyone away, regardless of ability to pay or immigration status. But what many people don’t know is what some hospitals do with seriously injured, undocumented patients once they are stabilized once it is discovered that they are uninsured and cannot pay for ongoing care.

Some bad actor hospitals in this situation take it upon themselves to deport ill or injured immigrant patients outside of the federal immigration process. This practice is known as forced medical repatriation.

By law, hospitals must provide emergency treatment to everyone regardless of immigration status or insurance coverage. However, once the patient is stabilized, hospitals are not reimbursed for any continued care that an uninsured patient may need. This situation may arise, for example, with comatose patients, patients needing regular dialysis, and patients with serious mental illness. The law prohibits hospitals from discharging a patient without arranging for transfer to an appropriate facility that ensures the patient’s health and safety. Yet long-term care facilities, rehabilitation centers, and nursing homes will not accept patients without insurance. In order to avoid continuing to provide care for these patients, then, some hospitals instead send immigrant patients to their home countries, frequently making inadequate or no arrangements for medical care upon arrival.

Only the federal government has the authority to deport immigrants, but these hospitals are taking it upon themselves to contact consulates, obtain passports, buy plane tickets, and even charter private planes to send undocumented patients abroad. In so doing, they are denying these patients both due process in immigration proceedings and the chance to consent to and participate in decisions about their own care.

While this practice may save the hospital some money, it can also come at the cost of the patient’s life. NYLPI and the Seton Hall Law School Center for Social Justice issued a report documenting more than 800 cases of attempted or successful medical repatriations across the United States in the past six years, including a nineteen-year-old girl who died shortly after being wheeled out of a hospital back entrance typically used for garbage disposal and transferred to Mexico, and a car accident victim who died shortly after being abandoned on the tarmac at an airport in Guatemala. Just this past summer, a Polish man who had lived in the United States for thirty years was put on a plane by a New Jersey hospital while unconscious; when he awoke, he found himself  back in Poland.

The practice of medical repatriation takes place largely in secret, so it is difficult to estimate the actual number of repatriations taking place around the country. What we do know is that undocumented immigrants will be at higher risk of repatriation starting next year when the federal government reduces charity care funding, making it even more difficult for hospitals to offset the cost of uncompensated care. Hospitals that regularly treat undocumented or uninsured patients may become even more likely to resort to repatriating patients that require long-term care.

It is therefore critical that we address the issue of medical repatriation now. We should call on hospitals and consulates to establish protocols to ensure that patients give informed consent before being discharged and that, in the event that a repatriation is made, they are sent to places where they can get the care they need. We should also urge the Department of Health and Human Services to issue regulations explicitly prohibiting involuntary repatriation of patients and imposing sanctions on hospitals that engage in this unlawful practice. It is high time we face head-on the deficiencies in the system that allow for these unlawful—and in many cases life-threatening—deportations to occur.

OPINION: Address community needs before closing hospitals

Check out the opinion piece written for the Brooklyn Daily Eagle by HJ team members Shena and Jenn about hopsital closures in low-income communities of color in Brooklyn and what they mean for access to care. You can read the piece here.

 

New Report on Health Needs, Gaps and Barriers to Care in North and Central Brooklyn Released in Conjunction with Proposed Redesign of Brooklyn’s Health Care System

See below—and congratulations to Shena, Jenn, and Alyssa for their hard work!

Brooklyn, NY (April 10, 2013)—In conjunction with the proposed redesign of Brooklyn’s Health Care System the Community Health Planning Workgroup (CPHW), a consortium of community stakeholders, healthcare providers and community health planners, today released The Need for Caring in North and Central Brooklyn, A Community Health Needs Assessment, sponsored by The Brooklyn Hospital Center, the I M Foundation, and the New York State Department of Health. The Community Health Needs Assessment, conducted by the Brooklyn Perinatal Network, the Commission on the Public’s Health System, and New York Lawyers for the Public Interest, sheds additional light on North and Central Brooklyn residents’ perception of the needs, gaps and barriers to care in their communities.

The report covers 15 zip codes, including Bedford Stuyvesant, Bushwick, Brownsville, Crown Heights, Cypresss Hills, East Flatbush, East New York, Flatbush, Fort Greene, Prospect Heights, Williamsburg, Downtown Brooklyn, Gowanus and Greenpoint, and addresses key findings, focus group results, and recommendations.

Field surveys and focus groups were used to capture the voices of the community. Community residents completed over 600 surveys, and 79 residents participated in nine focus groups targeting groups underrepresented in the survey sample, including teens; individuals with disabilities; Spanish speakers receiving mental health services; immigrants; men aged 18-35 and 45-55; senior citizens; pregnant women; and LGBTQ individuals.

Following the completion of the Community Health Needs Assessment, listening sessions were held to solicit community input and feedback concerning the findings.

Among the key findings:

• The report found the most common illnesses/health conditions among residents surveyed were high blood pressure/hypertension (24.8%), followed by asthma (19.9%); diabetes (15.7%); and hearing or vision problems (15.2%).
• 85% of respondents said that it would be most convenient to receive care in their neighborhood; almost 20% of the sample (18.7%) received none of their care in their community.
• 50% of residents surveyed said they or members of their household had visited an emergency room in the past two years.
• When asked which healthcare services households had difficulty accessing in their neighborhood, 100% of respondents said a dentist.
• Half of respondents had a limited ability to secure health care services. When asked why, 48% said barriers to health care included quality of care, culture and language differences, hours of service and attitudes of providers; 19.8% said insurance issues or lack of insurance; 23.1% said long waits for or at appointments; and 9.1% said cost of care.

“We are really pleased to have had the opportunity to ensure that the community’s voice is a driving factor in how healthcare is delivered and look forward to the healthcare planning developments that come from the CHNA process. We are hopeful that our process will serve as a model way to meet the needs of communities being served,” said Shena Elrington of New York Lawyers for the Public Interest who served as co-lead partner in the development of the report.

The report concluded with approximately 15 critical recommendations to improve healthcare in Brooklyn. These included addressing accessibility; improving screening, outreach, cultural and linguistic competency, patient-centered care, and customer service training; providing extended hours for primary care; increasing awareness and access to low-cost health services/insurance; providing financial support of efforts by grassroots community-based organizations (CBOs) to promote community resources; coordinating a network of health care and social service providers; engaging community residents; targeting services to focus on particular illnesses and communities; increasing access to specific health care services; working with Access-A-Ride to address transportation issues; increasing the number of providers who accept public health insurance; and increasing availability and access to mental health services.

To read the full report, click here. To read a summary of the report, click here.

A Victory in Combating Segregated Health Care in New York Hospitals

by Jenny Bright, Intern, Health Justice Program

On May 10, we continued our efforts to end segregated health care in New York Hospitals with a hearing before the New York State Assembly Health Committee, chaired by the Honorable Richard N. Gottfried.

The hearing was a major victory in our efforts!  60-70 people showed up to support our Health Equity Bill, A07699, sponsored by New York State Assemblymember Nelson Castro.  Members of the community and community group representatives provided compelling testimony.

Thank you, in particular, to those who helped and participated.  We look forward to continuing to make headway!

Segregated Health Care & the Latino Communitiy

Last week, we met with the New York State Assembly/Senate Puerto Rican and Hispanic Task Force to discuss the issue of segregated care in New York private teaching hospitals and our Health Equity Bill (A07699/S5785).

We brought a small but mighty group of advocates, doctors, and community residents to present before the Task Force on this important issue. According to 2009 United Hospital Fund data, 61.2% of Latinos in New York are on Medicaid or uninsured – meaning that the steering of patients based on insurance type has a particularly strong impact on the Latino community. Access to quality-health care is already difficult for Latinos – language/cultural barriers, above-average poverty rates, restrictions on health care for immigrants, etc. – so the addition of unfair hospital policies, like segregated health care, which have no medical, financial, or moral grounds should not be allowed to continue in New York.

Our bill will make it illegal to separate patients based on insurance type so that all patients are treated with the same care, in the same setting, and with the same respect once they enter a hospital.

Special thanks to our partners, Bronx Health REACH, and bill sponsors, Assemblymember Nelson Castro and Senator Gustavo Rivera for joining us at the Task Force meeting.

Below, you can watch our presentation:

NYS Assembly/Senate Puerto Rican & Hispanic Task Force Meeting 02.29.12 from Somos New York

To view our powerpoint presentation from the Task Force meeting, click here.