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Unpaid Hospital Bill Leads to Deportation

Christy Carnegie Fujio, JD, MA, and Juliana Morris on June 30, 2011

Could deportation be a consequence for an unpaid hospital bill? It was for Quelino Ojeda Jimenez, a young day laborer who, up until this past February, had been receiving long-term care at the Advocate Christ Medical Center in Chicago. Mr. Ojeda was admitted to the hospital in October of 2010, in critical condition after falling off a roof at work. After being stabilized by the hospital medical team, he continued to require long-term care.

But since Mr. Ojeda is an undocumented immigrant with no insurance, a limited social network in the US, and no access to private long-term care facilities, no one was able to pay the bill. Advocate Christ was stuck – they could either continue to provide costly, daily medical care for Mr. Ojeda for an indeterminate amount of time, or they could arrange for his transfer to a facility that would care for him in his home country. The administrators at Advocate Christ opted for the latter.

Mr. Ojeda’s case is hardly unique. Each year there are 100 similar cases of medical repatriations. To discharge the patient, hospitals typically hire a company that specializes in international medical transfers, for a lump sum of approximately $60,000 per patient. Before the repatriation can take place, the company has the patient sign a form indicating their consent to the transfer. The hospital must also go through the discharge process and a physician must authorize the transfer.

Unfortunately, in most cases it is not simply a transfer from one facility to another of equal quality. Patients typically are moved to resource-poor settings where they receive significantly decreased quality of care and negative health outcomes. When Mr. Ojeda returned to Mexico, his nurses were reusing old filters in his ventilator due to their limited availability and high cost. Even if Mr. Ojeda himself had consented to the transfer, the harm caused to his health by the change in care quality raises serious ethical questions.

What can be done to begin to address this issue? Hospitals are suffering from real financial challenges, immigrant patients have limited resources, and many physicians are paralyzed by this “dual loyalty” dilemma: should they approve transfers because their employer cannot afford to continue providing care, or should they insist on the best care possible for their patients even if it bankrupts the hospital?

To date desperate hospitals have quietly carried out these transfers, and while they effectively operate as deportations, US Citizenship and Immigration Services has failed to oversee or govern the process as it should.

Since this is a complex issue involving multiple government agencies, private actors, and the entire health care industry, solutions will be hard to find. But systems need to be developed that will preserve human rights for immigrant patients in long-term hospital care while allowing hospitals to do what is necessary to remain solvent. At a minimum, guidelines and proper oversight of the process of medical repatriations process must be introduced immediately.

To learn more about this issue and find out how you can get involved, visit the related webpage by New York Lawyers for the Public Interest.

Places: United States