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.