Are U.S. Hospitals Guilty of "International Patient Dumping"?

The U.S. failure to pay in perpetuity for an illegal immigrant's expensive medical care is the result of "two deeply flawed American systems, immigration and health care."

Sunday's Times led off with a three-column, 6,000-word expose of the American health care system by Deborah Sontag, "Deported, by U.S. Hospitals," focusing mostly on the case of Luis Alberto Jiminez, an illegal immigrant sent backto continue his rehabilitation inhis home country of Guatemala after being injuredin acar accidentin Florida. The tone was hugely sympathetic toward the admittedly tragic plight of ill and injured illegal immigrants.Thehospitals and U.S. taxpayers expected to pay for the often expensivetreatments (Martin MemorialHospital had already spent $1.5 million on Jiminez) didn't get off as easily.

High in the hills of Guatemala, shut inside the one-room house where he spends day and night on a twin bed beneath a seriously outdated calendar, Luis Alberto Jiménez has no idea of the legal battle that swirls around him in the lowlands of Florida.

Shooing away flies and beaming at the tiny, toothless elderly mother who is his sole caregiver, Mr. Jiménez, a knit cap pulled tightly on his head, remains cheerily oblivious that he has come to represent the collision of two deeply flawed American systems, immigration and health care.

If the U.S. systems are so deeply flawed, then why was Jimenez over here illegally in the first place instead of his home in Guatemala? Perhaps Guatemala has some problems in its own economic system? But it's easier for the Times to simply blame U.S. policy.

Eight years ago, Mr. Jiménez, 35, an illegal immigrant working as a gardener in Stuart, Fla., suffered devastating injuries in a car crash with a drunken Floridian. A community hospital saved his life, twice, and, after failing to find a rehabilitation center willing to accept an uninsured patient, kept him as a ward for years at a cost of $1.5 million.

What happened next set the stage for a continuing legal battle with nationwide repercussions: Mr. Jiménez was deported - not by the federal government but by the hospital, Martin Memorial. After winning a state court order that would later be declared invalid, Martin Memorial leased an air ambulance for $30,000 and "forcibly returned him to his home country," as one hospital administrator described it.


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.

Later Sontag admitted the costs such free-rider cases impose on the U.S. health care system:

Mr. Jiménez was a very expensive charity case. In cases like his, where patients need long-term care, hospitals are not allowed to discharge them to the streets. Federal regulations require them - if they receive Medicare payments, and most hospitals do - to transfer or refer patients to "appropriate" post-hospital care.

But in most states, the government does not finance post-hospital care for illegal immigrants, for temporary legal immigrants or for legal residents with less than five years in the United States. (California and New York City are notable exceptions; Medi-Cal, the state's Medicaid program, spends $20 million a year on long-term care for illegal immigrants, as does the Health and Hospitals Corporation of New York City.)

Sontag only briefly touched on the core problem- impoverished Guatemala's inability to properly care for its own citizens.

At that point, the hospital intensified its efforts to involve the Guatemalan government in the case. In a memorandum obtained by The New York Times, a consular official wrote that the hospital "informed us of how expensive it was becoming to care for Luis given that there was no insurance and that he is illegal and that the state won't assume responsibility for his charges."

Eventually, the Guatemalan health minister wrote a letter assuring Martin Memorial that his country was prepared to care for Mr. Jiménez. Gabriel Orellana, who was foreign minister at the time but did not have direct knowledge of the case, said the Guatemalan government was disposed to assist an American institution. "If a hospital in Florida asks if we can take care of a Guatemalan patient, the tendency is to say yes," Mr. Orellana said.

Mr. Gaspar [Jimenez's cousin and guardian in Florida] was dubious, believing the public health care system in his homeland to be grossly inadequate.

So the guardian and the hospital reached an impasse, and Martin Memorial finally took the matter to court, asking a state judge to compel Mr. Gaspar to cooperate with its repatriation plan. In June 2003, a hearing was held before Circuit Judge John E. Fennelly.

Sontag also co-authored the Times' notorious "Killer Vets" story, which use nonsense statistics to make the case that troops were coming home from Iraq and Afghanistan and committing felonies.