Hospital Deportation of Chronically Ill but Stable Illegal Immigrants: “Patient Dumping”?
This excerpt from an article by Debra Sontag in the August 3 2008 issue of the New York Times sets the ethical and legal issue. She writes:
Mr. Jiménez’s benchmark case exposes a little-known but apparently widespread practice. Many American hospitals are taking it upon themselves to repatriate seriously injured or ill immigrants because they cannot find nursing homes willing to accept them without insurance. Medicaid does not cover long-term care for illegal immigrants, or for newly arrived legal immigrants, creating a quandary for hospitals, which are obligated by federal regulation to arrange post-hospital care for patients who need it.
American immigration authorities play no role in these private repatriations, carried out by ambulance, air ambulance and commercial plane. Most hospitals say that they do not conduct cross-border transfers until patients are medically stable and that they arrange to deliver them into a physician’s care in their homeland. But the hospitals are operating in a void, without governmental assistance or oversight, leaving ample room for legal and ethical transgressions on both sides of the border.
Indeed, some advocates for immigrants see these repatriations as a kind of international patient dumping, with ambulances taking patients in the wrong direction, away from first-world hospitals to less-adequate care, if any.
The ethical question is was justice served by the U.S. government to place a burden on all hospitals, requiring them to treat all patients who enter their emergency room (including illegal aliens or the newly arrived legal immigrants) , (EMTALA law),not to transfer them until they become clinically stable for transfer to another facility but then ignoring the hospital’s dilemma when they are unable to find another facility for transfer, the patient ending up as a long term resident of the admitting hospital. There is no financial compensation to the hospital by the government for the prolonged stays and chronic treatments, once the patient is stable, if the patient is unable to pay. Of particular complexity is, as described in the article, when the patient is a citizen of another country. There are no federal regulations or state laws regarding how and under what conditions these patients can be returned to their country of origin.
My questions are: how much responsibility should hospitals be given in the final disposition of an illegal alien who has been stabilized and is ready for transfer to a facility for prolonged care but there is no facility to accept the patient since the patient may not be able to pay for such care and there is no payment by the U.S. government? Should the admitting hospital continue to care for the chronically ill but stable patient indefinitely assuming all costs? Should the hospital involved take the responsibility for deporting the patient to the country of origin? Is returning a chronically ill but stable patient to such a country that has lesser facilities for prolonged care essentially “patient dumping”? Should the U.S. government, rather than the individual hospital, be responsible for the cost of medical care and process of deportation of illegal immigrant patients? ..Maurice.
posted by Maurice Bernstein, M.D. @ 11:07:00 AM
4 comments
4 Comments:
You may find this comment as either inhumane or far-fetched, however it is meant in all sincerity. Once an Illegal Alien is stable (which many would believe is doing too much – but I will give them a little leniency) they should be transported to the U.S. Capitol – they have a medical staff on site. Let the patient count build up and let our Congressional “leaders” see what an uncontrolled immigration system is doing in America.
Over-crowded emergency rooms, nursing and rehab centers are just a couple of the challenge that the Illegal Immigration crises are causing the tax paying citizens of this country.
Immigrants who have the right to be here should be taken care of.
Sound mean? Hey – it is a chance they take when coming into this country illegally and break the laws of the place they wish to call home.
Come on folks – wake up. Illegal Immigration must be dealt with.
Our Congress must pass a resolution that ALL illegal aliens, once stabilized, will be returned to their country of nationality (where they hold citizenship). The feds need to appoint a section of ICE to handle and make arrangements. We contact the illegal aliens's appropriate governmental department to inform them they need to make receiving (and care arrangements, if necessary) for their returning citizen. The onus of responsibility is now on them because all we will be doing is returning them to the country, as our obligations (we never had any really to begin with, since the person was an illegal alien). We should be provinding nothing but emergency care services for illegal aliens. Nothing more.
The blame rest on the Federal Goverment with their lack of enforcing our Immigration laws. If I was the C.E.O. of the hospital. I would partnership with other hospital seeking federal money to cover the expense of illegal Immigrates using their hospitals. Before their hospitals go bankrupt.64 hospital here in Arizona and California have already seen this fate in the past 5 years.. If the family of the patient is unwilling to take care of this patient. I would send them to the cheapest nursing home in the country. Of course the hospital would end up paying but, isn't this much cheaper than using up hospital bed for a year?
Based on the information I have available, the Medicare Modernization Act of 2003 allocated money to reimburse hospitals specifically for the care EMTALA requires for illegal aliens who come to the hospital (but not for U.S. citizens). However, it is my understanding that EMTALA has never been funded by Congress. For the hospitals, the government gave high hopes but as usual failed to act. ..Maurice.
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