When The Cost Of Care Triggers A Medical Deportation
In an emergency, hospitals, by law, must treat any patient in the U.S. until he or she is stabilized, regardless of the patient's immigration status or ability to pay.
Yet, when it comes time for the hospitals to discharge these patients, the same standard doesn't apply.
Though hospitals are legally obligated to find suitable places to discharge patients (for example, to their homes, rehabilitation facilities or nursing homes), their insurance status makes all the difference.
Several years ago I began caring for a man who'd been in our hospital for more than three months. He was in his 50s and had suffered a stroke. Half his body was paralyzed and he couldn't swallow food. After weeks of intensive physical, occupational and speech therapy, he regained his abilities to eat, drink and walk with only minimal help. But he still wasn't well enough to live on his own, prepare food or even get to the toilet by himself.
Ideally, we would have discharged him from the hospital to a rehabilitation facility so he could continue therapy and make more progress toward his prestroke state.
But our plan faced insurmountable barriers. First off, the patient was an immigrant who had entered the country illegally. Second, he didn't have insurance.
Because he lacked health coverage, no other facility would accept him. His immigration status meant that we couldn't find an outside charity that would cover the costs of his care or pay for insurance.
Our comparatively expensive acute care hospital was therefore compelled to hold him — with the meter running. After another month, it began to seem that he'd become a permanent resident of our hospital ward.
"Could he go back to Mexico?" our case manager asked.
We were startled. No one on my team had ever experienced a situation like this, so we began researching the possibility. As it turned out, it's a murky legal and ethical area that drew some public attention after an expose in The New York Times in 2008.
https://www.npr.org/sections/health-shots/2016/04/09/473358504/when-the-cost-of-care-triggers-a-medical-deportationDuring the summer invasion I saw people coming in by wheelchair. They are coming sick. Boy that's some kind of preexisting medical deal for illegal immigrants.