Health Care
12:00 pm
Wed May 1, 2013

Deported While Unconscious

Transcript

MICHEL MARTIN, HOST:

I'm Michel Martin, and this is TELL ME MORE, from NPR News. Coming up, you might be thinking about freshening up your spring wardrobe, and you might find yourself excited by the low prices being advertised at your favorite store at the mall. And then you hear that there were hundreds of deaths at a factory in Bangladesh. Our next guest is going to tell us what one might have to do with the other. We'll have that conversation in just a few minutes.

But first, we want to talk about a human rights issue in this country. A number of American hospitals have come under fire recently for deporting undocumented immigrants who were under their care. These patients - as many as 600 in the last five years - were sent back to their home countries, sometimes while they were unconscious, and frequently without any court or federal agency reviewing the decision. It's been called medical repatriation, and David Pitt reported on this for The Associated Press. He's with us now.

Welcome. Thank you so much for joining us.

DAVID PITT: It's a pleasure to be here. Thank you.

MARTIN: I want to emphasize that the number we just cited - as many as 600 in the last five years - was not your number. This was a number that was compiled by the Center for Social Justice at Seton Hall Law School. And in your piece, you quote the director, Lori Nessel, as saying that this is taking place in an unregulated sort of black hole.

So, first, I just wanted to ask you: How did they arrive at that number, and why do they use that term?

PITT: Well, their number is compiled from media reports, interviews with hospitals, interviews with individuals in locations like Mexico and Guatemala. So they've done a few years of research, and that's the conservative estimate. Professor Nessel tells me that they believe there probably is significantly more than that. There are cases, really, around the country.

And then, of course, the story that I wrote was based on one that happened here where I'm located in Des Moines, Iowa.

MARTIN: And I want to talk about your piece. Your article focuses on two men, Jacinto Cruz and Jose Rodriguez-Saldana, who were injured in a car crash, but one of the things that fascinated me about their case is that they had health insurance through their work at one of the country's largest pork producers. So how did their situation come about?

PITT: Well, their situation developed when the hospital - you know, it has to take them. They were in an accident in which they were both thrown from the car, had severe head injuries and, in that case, any hospital in the United States that takes Medicare funding from the federal government has to take a patient - regardless of their immigrant status or their ability to pay - until the patient is at least stabilized.

These gentlemen did have medical insurance that paid, between the two of them, up to about $100,000 of their care. And then the gentlemen got to the point where they were stabilized, and the hospital was making preparations to transfer them somewhere else. And the federal law says they have to have adequate care once they're transferred, which, for these gentlemen, would have meant a nursing home or rehabilitation center, and there was no rehabilitation center that would take them. The fact that they were undocumented immigrants and the fact that the insurance company may or may not pay was enough of a question that the rehab centers wouldn't take them. And so the hospital began looking at options, and one of those options was to take a look at a hospital in Mexico and send them back home, and that's what they did.

MARTIN: They were Mexican nationals.

PITT: That's correct.

MARTIN: We're using this term medical repatriation. But what happens when people are actually sent home at this level of disability? Do we even know?

PITT: We do. Typically, what happens is the hospital, in many instances, would contact the consulate from the home country, whether it's Guatemala or Mexico. It could be others. There's a case out of Chicago where it was Poland. They typically contact at least some government official - sometimes, it's a local government official - to help make the proper documentation to get the patients transferred. But usually, it is a transaction simply between the hospital that's sending the patients home and a hospital on the other end.

The hospital here in the United States typically pays for a private flight. They just basically hire a service, and there are companies that have come into being just to help, you know, help facilitate these types of transfers. And so they're transferred, and it's a private hospital, a hospital transfer, typically.

MARTIN: Is the...

PITT: The government doesn't get involved.

MARTIN: Well, what does the hospital say about this?

PITT: Well, the hospital says that they did go through the procedures of contacting the family, and the family members were presented with options for what to do with the two men. And the option that was really available to them was to send them back to Veracruz, Mexico, to a hospital there. The family would argue with that assessment.

The hospital also says that they believe that patients heal better when they're close to their loved ones and their families, and these gentlemen had no families in the United States and nowhere to send them. So they believe they did what they, you know, could only do, and one of the doctors I talked to said that it's just kind of a catch-22 for hospitals. You know, they have to take them when they're seriously hurt and they have to stabilize them, but then the hospitals are not given any financial capability of handling them.

And there have been cases - in Chicago, there was a case where a woman lived in the hospital for a year, and the hospital incurred more than a million dollars in care before they sent her back to Poland, where she is living now.

MARTIN: What does the law say, though? I mean, you're saying that the hospitals comply with the law that says that they're required to stabilize people, but...

PITT: Right.

MARTIN: ...which they have done. But are they required to provide long term care for people who are seriously injured who are not citizens? What's the controlling principle here?

PITT: I think that's the problem, and I think when Dr. Nessel talked about, you know, when I interviewed her for the story, talked about how there's this kind of this black hole, this unregulated kind of space, the Iowa Court of Appeals - which dealt with the case here - actually called it a regulatory quagmire. It's just kind of that intersection between health care and immigration, where there really is no law that says, you know, once a patient is stabilized and they're no longer a critical care patient, you know, that they have to go X, Y or Z. There's no location, or there's no one that has to take them. There's no recipient that is required by law to pay for this, you know, this health care.

MARTIN: You know, there's still a lot of controversy around the Affordable Care Act, which - you know, Obamacare to critics. But a lot of the health care exchanges and things that would, you know, offer or extend health care to people who don't currently have it haven't kicked in yet. Will this change when the law is fully implemented?

PITT: The people that I talk to believe that it actually could get worse. And I think the reason why they believe it could get worse is because the law will send fewer dollars to some of these hospitals that, again, are Medicare recipient hospitals, that some of that money will tighten up because more people will obviously be eligible for the Medicaid program, for the - you know, the health care program that the United States currently has for a number of people, including those who are indigent or elderly.

And so I think that there's the belief that since some of that money that goes to hospitals now, that takes care of patients who come in without any financial resources may go away, most immigrants - there are a few exceptions, but most immigrants without documentation aren't eligible for the new health care program, or through the existing health care Medicare or Medicaid programs. And, like I said, there are some exceptions, but most are not. So there's really nowhere for them to turn, you know, for the government to pay for their services.

MARTIN: What about the two men you wrote about? How are they doing?

PITT: One uses a wheelchair and is very emotional. He became quite emotional in the interview with us. And he is very frustrated that he can't work, and he's not able to be as mobile as he used to be. The other gentleman wears leg braces and goes to physical therapy frequently. I think they do have lasting - you know, a lasting impact from the accident, and they believe that their rapid transfer back to Mexico to a hospital that didn't have the facilities and the capability of helping them with the rehabilitation they needed probably impeded their ability to get back to normal and to a way that they would like to function.

MARTIN: Your story has gotten thousands of comments so far. Can I just ask you: What stood out for you in this?

PITT: Just the fact that it's generated the kind of discussion that it has indicated to me that this is something that happens kind of quietly around the country. It's a regulatory quagmire. There are a lot of these cases that are not documented, and that just made me think, well, there might be something here that people would find very interesting, that maybe people should take a look at and consider: You know, where do we go with this, as far as, you know, federal regulation, as far as guidelines? And what do we do with it?

So I don't have an opinion on what should be done. I just really am happy to be able to tell the story so that the debate can begin on whether it belongs in the immigration debate, or whether it belongs in health care.

MARTIN: David Pitt is a reporter for The Associated Press. He was kind enough to join us from Iowa Public Radio in Des Moines. David Pitt, thank you so much for speaking with us.

PITT: Thank you. It's a pleasure to be here. Transcript provided by NPR, Copyright NPR.

Related program: