PHILADELPHIA — An undocumented, seriously injured Guatemalan immigrant who supporters say was nearly “medically repatriated” by Jefferson Health to a homeland less able to help him has now been moved to a long-term care facility in the Philadelphia region.
“If we had not gone to the hospital and raised a stink, he would be in Guatemala right now, and might not be alive right now,” said Philadelphia immigration lawyer David Bennion, director of the Free Migration Project, an advocacy organization.
Bennion declined to say where the man, identified by his family only as A.V., is now being treated, because that could alert ICE agents to his location. A.V. suffered a traumatic brain injury when he was hit by a motorcycle, and his long-term prognosis is uncertain, but his family believes that American medical care represents his best hope for recovery.
Guatemala struggles to provide basic health care for less-wealthy citizens even in good times, and today the largest country in Central America is being ravaged by the coronavirus.
A.V. has become the public face in Pennsylvania of an unregulated, little-known practice that’s been criticized as “international patient dumping,” in which hospitals send costly, uninsured immigrant patients back to poorer homelands. It’s usually only a matter of time before those patients die there, because they cannot afford the care they need, according to a study by Jennifer Smith, a professor at the Florida A&M University College of Law.
Asked about A.V.’s move from Jefferson Torresdale Hospital in Northeast Philadelphia, a health-system spokesperson said she could not share specifics about any particular patient, but “Jefferson Health transfers patients in coordination with the patient, or if the patient cannot consent, a family member or their legally appointed decision maker. … Jefferson works very closely with family members to develop transfer or discharge plans, no matter how complex.”
Bennion and A.V.’s niece, Claudia Martinez, dispute that. They say Jefferson sought only to rid itself of the cost and complications of his care.
“My uncle is much better, is better attended, and when we talk on the phone he can recognize me, but he is still quite confused,” Martinez said. “What I want to happen is that he recovers, that he has the care and attention that he needs no matter how long it takes. … My family is in total agreement on what is best for my uncle.”
The drama became public on June 23 amid outcry from medical students who organized an online petition to stop the removal. A.V. had been brought to Jefferson Torresdale in May after suffering broken legs, fractured ribs and severe neurological trauma when he was hit by a motorcycle. On June 24, immigration activists gathered at the hospital for what they said would be a physical attempt to block any vehicle carrying him to the airport.
That proved unnecessary. By afternoon, amid continuous news coverage and the arrival of City Councilwoman Helen Gym and other officials, any plan to remove the 48-year-old had been halted.
A health-system statement issued at the time did not deny that A.V. was being, in effect, privately deported, but said all transfers are the result of planning between hospital staff, patients, and families.
U.S. Immigration and Customs Enforcement played no role in the case.
More than 6,400 people ultimately signed a petition on A.V.’s behalf.
The situation emerged not only amid a lethal pandemic but also during national protests over systemic racism in policing, government, courts, and medicine. Doctors and nurses in Philadelphia and elsewhere marched to demand an end to health disparities and better treatment for Black Americans and others, including immigrants, who often lack access to high-quality care.
So-called medical repatriations of undocumented migrants have gone on quietly for a long time in the U.S., and often patients have not given their consent, according to the Norris McLaughlin law firm, which practices in Pennsylvania, New Jersey, and New York. Decisions are made by insurance companies, doctors, hospital financial officers and administrators, and patients and their families are not necessarily part of those discussions, the firm said.
Hospitals are bound by federal laws to arrange post-stay care for patients who need it. But such cases present financial predicaments, particularly with patients whose brain injuries can require lifelong care.
Undocumented patients generally are ineligible for government-paid services, so hospitals may not be able to discharge them to nursing homes or home-care facilities. Community agencies won’t take on huge costs with no chance for reimbursement. That means hospitals can see their choices as limited: Keep the patients forever, or remove them to their homelands by flights and ambulances, a practice criticized as “screen, stabilize and ship.”
Undocumented immigrants can be eligible for certain discrete medical-assistance programs. A.V.’s care is being paid for by Emergency Medicaid, a special government-sponsored function of the larger Medicaid health program. The funding is not indefinite. Emergency Medicaid, which is administered by the states, provides help to people who suffer a critical medical situation.
Now that A.V. has left Jefferson Torresdale, Bennion said, efforts to help him are focusing on new, potential challenges:
There’s concern that A.V. may not be protected from arrest under the ICE sensitive-locations policy, which dissuades agents from taking action at hospitals, schools and churches. While the policy designates “medical treatment and health-care facilities” as off-limits, it specifically names them as “hospitals, doctors’ offices, accredited health clinics, and emergent or urgent care facilities.”
A.V. also could be at risk of arrest upon leaving the long-term care facility.
In addition, while A.V. is undocumented, having lived about 20 years in the United States, it’s uncertain whether he may have had legal status in the past. Bennion is seeking to locate any documents connected to his status. A.V.’s family also is attempting to raise money to help his mother in Guatemala, as she has depended on funds sent to her by her son.
“His family is very interested in making sure this doesn’t happen to someone else,” Bennion said. “Somebody made the decision, ‘We’d rather hire a private flight to Guatemala.’ … His family believes he wouldn’t be alive right now if that plan had gone forward.”
©2020 The Philadelphia Inquirer