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.