Hospitals are deporting uninsured patients. This reporter says it's a legal gray area

Here’s a phrase you might not have heard of: Medical deportation. It’s pretty much what it sounds like: When hospitals transfer critically ill, uninsured patients to hospitals in other countries rather than arranging long-term care in the United States. And a reporter has documented multiple cases of it going back years.

Gabriela Ramírez is an investigative reporter who reported the story for the Spanish-language news outlet Conecta Arizona with a grant funded by the USC Annenberg Center for Health Journalism National Fellowship.

She told The Show most of the cases she found involved undocumented people. But there were also cases where hospitals attempted to deport legal permanent residents and U.S. citizens.

The Show also reached out to Dignity health, which runs St. Joseph's Hospital, and asked for comment on this story. They said they were unable to respond.

Gabriela Ramírez

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Handout

Full conversation

GABRIELA RAMÍREZ: Under EMTALA, which is federal law, every hospital must treat emergency conditions regardless of the patient's ability to pay or their immigration status. And once this person has been stabilized, they must ensure a safe discharge. But when a patient needs long-term care and has no insurance, some hospitals opt to send them abroad.

So this is where it goes into the shadows of the law, let's say.

LAUREN GILGER: Right, so it's sort of a legal gray area.

RAMÍREZ: Yeah, exactly. And I think it is important to mention that it is not really what we are seeing right now in the news, with ICE rates and workplace enforcements, all these mass deportations that the government is enforcing.

These are actually private hospitals, nonprofit hospitals. They are the ones arranging these transfers. They are hiring private ambulance companies, chartering medical flights and coordinating with the hospitals, which will receive the patients abroad.

So it's like the government isn't ordering these deportations, and ICE isn't involved at all. In many of the cases, the patients don't even have deportation orders. So when hospitals do this, they are essentially doing what even ICE couldn't legally do in some cases.

GILGER: So without the government being involved, hospitals are choosing to do this. Is it a cost issue for them? Like, what do hospitals tell you about why they would do this?

RAMÍREZ: Yeah, so hospitals will tell you that they can afford to provide long-term care to uninsured patients. But when you actually look at the numbers, that argument falls apart pretty quick.

We talked to Eric Manheimer, who was the director of the Bellevue Hospital in New York for over 13 years, and he completely dismissed the cost argument.

He told us that the reason health care is denied in the United States is political and social, not economic.

GILGER: It just seems so surprising to me, because doctors take an oath in the United States to do what's best for their patients. In these cases, is it often what's best for their patients to be transferred to another country?

RAMÍREZ: So in many cases, as Eric Manheimer also told us, maybe the person is in a final stage of their life and they do want to return home and they do want to be close to their families in that very vulnerable moment of their lives.

But in many cases, actually those patients don't even have family in the United States, or these decisions are made without their consent, or they are sent abroad and there is no one who receives them after they land in the country that will receive them.

And that's why many immigration lawyers describe this forced medical repatriation as coercive and potentially illegal under civil and human rights law. Some families have successfully fought back in court.

GILGER: So let's pause for a moment, Gabriela, and just have you tell us a story or two of some of these kinds of cases that you have documented here and that have been documented before.

It sounds like here in Arizona, you found several cases of this kind of medical deportation dating back to 2007, 2008. Tell us about one or two of those.

RAMÍREZ: One of these cases is the case of Antonio Torres. He was 19 years old, a legal permanent resident living in Gila Bend, when a car accident left him with a severe brain injury. Two days after the accident, the St. Joseph Hospital, the staff pressured his family to remove him from life support, saying there was little hope for him to survive.

When the family refused, the hospital arranged to transfer him to a hospital in Mexicali, Mexico, against the family's wishes. He was left four hours under the summer sun at the border, kept alive by a portable ventilator until a Mexican ambulance picked him up.

When he arrived at the public hospital in Mexicali, there were no beds available. His infection spread, and his body went into septic shock.

But the community in Arizona and his family, they all got together and rallied. They raised the money to bring him back to a hospital in California. And 18 days after arriving there, Antonio thankfully woke up from his coma, and the first thing he asked was where his mother was.

So these are the kind of cases we have been hearing and reporting on since we started doing this investigation.

GILGER: Yeah. Let me ask you, Gabriela, lastly, about what is happening now. I know this is hard to track because it isn't tracked anymore in any kind of national way.

But under the current administration and as we're seeing mass deportations happen around the country, are we seeing more instances of these medical deportations?

RAMÍREZ: Unfortunately, yes. And advocates say they are increasing. For this research, we connected with a team at Seton Hall Law School, and they did one of the only comprehensive studies we have.

So between 2006 and 2012, they documented over 800 cases of medical deportations or attempted deportations, but nobody counted since then. And this is the huge gap of knowledge that we have now.

But they actually went to Guatemala and tracked down what happened to people after they were deported. They shared their findings with us, and the numbers are devastating. Ninety percent of the people who were medically repatriated were in critical condition or had serious medical needs when they were sent back.

And get this, in 80% of the cases that the Guatemalan consulate reviewed, the transfer happened without valid consent. The families didn't truly agree to this. They were pressured. They were given impossible choices, and they didn't even understand what was happening.

And of the 13 cases where they could actually follow up and see what happened after the person arrived in Guatemala, seven received no medical care at all, and six of them died.

What also the Free Migration Project told us is that in this climate that we are under, these deportations are becoming very creative and audacious. In one of the recent cases, a hospital discharge plan for a patient with a vision loss consisted of buying him a tent and dropping him off at a homeless encampment.

So really, again I believe that this political climate is emboldening hospitals. With immigration enforcement intensifying and cuts to health care programs, there is a sense that no one is going to care.