Deportation without consulting any court

Days after they were badly hurt in a car accident, Jacinto Cruz and Jose Rodriguez-Saldana lay unconscious in an Iowa hospital while the American health care system weighed what to do with the two immigrants from Mexico.

The men had health insurance from jobs at one of the nation’s largest pork producers. However, neither had legal permission to live in the U.S. Nor was it clear whether their insurance would pay for the long-term rehabilitation they needed.

So, Iowa Methodist Medical Centre in Des Moines, after consulting with the patients’ families, quietly loaded the two comatose men onto a private jet that flew them back to Mexico, effectively deporting them without consulting any court or federal agency.

Obscure process

When they awoke, they were more than 1,800 miles away in a hospital in Veracruz, on the Mexican Gulf Coast.

An obscure process known formally as “medical repatriation”, allows hospitals to put patients on chartered international flights — for which they pay — often while they are still unconscious. Now, advocates for immigrants are concerned that hospitals could soon begin expanding the practice after full implementation of federal health care reform, which will make deep cuts to the payments hospitals receive for taking care of the uninsured.

“It really is a Catch-22 for us,” said Dr. Mark Purtle, vice president of Medical Affairs for Iowa Health System, which includes Iowa Methodist Medical Centre. “This is the area that the federal government, the state, everybody says we’re not paying for the undocumented.”

That’s why hospitals often try to send those patients to rehabilitation centres and nursing homes back in their home countries.

Civil rights groups say the practice violates U.S. and international laws and unfairly targets one of the nation’s most defenceless populations.

“They don’t have advocates, and they don’t have people who will speak on their behalf,” said Miami attorney John De Leon, who has been arguing such cases for a decade.

Estimating the number of cases is difficult since no government agency or organisation keeps track.

The Centre for Social Justice and New York Lawyers for the Public Interest have documented at least 600 immigrants who were involuntarily removed in the past five years for medical reasons. Some patients who were sent home subsequently died in hospitals that weren’t equipped to meet their needs. Others suffered lingering medical problems because they never received adequate rehabilitation, the report said.

Gail Montenegro, a spokeswoman for U.S. Immigration and Customs Enforcement, said the agency “plays no role in a health care provider’s private transfer of a patient to his or her country of origin”.

Such transfers “are not the result of federal authority or action”, she said in an email, nor are they considered “removals, deportations or voluntary departures” as defined by the Immigration and Nationality Act.

Undocumented

The two Mexican workers in Iowa came to the U.S. in search of better jobs and found work at Iowa Select Farms, which provided them with medical insurance even though they had no visas or other immigration documents.

Mr. Cruz had been here for about six months, Mr. Rodriguez-Saldana for a little over a year. The men were returning home from a fishing trip in May 2008 when their car was struck by a semitrailer truck. Both were thrown from the vehicle and suffered serious head injuries.

Insurance paid more than $100,000 for the two men’s emergency treatment. But it was unclear whether the policies would pay for long-term rehabilitation. Two rehabilitation centres refused to take them.

Eleven days after the car crash, the two men were still comatose as they were carried aboard a jet bound for Veracruz, where a hospital had agreed to take them.

Mr. Rodriguez-Saldana, now 39, said the Des Moines hospital told his family that he was unlikely to survive and should be sent home.

Patients are frequently told family members want them to come home. In cases where the patient is unconscious or can’t communicate, relatives are told their loved one wants to return, Mr. De Leon said.

In court documents, Iowa hospital officials said they had received permission from Mr. Rodriguez-Saldana’s parents and Mr. Cruz’s long-term partner for the flight to Mexico. Family members deny they gave consent.

There’s no way to know for sure whether the two men would have recovered faster or better in the United States. But the accident left both of them with life-altering disabilities.

Nearly five years later, the 49-year-old Mr. Cruz is paralysed on his left side, the result of damage to his hip and spine. He has difficulty speaking and can’t work.

Mr. Rodriguez-Saldana said he has to pay for intensive therapy for his swollen feet and bad circulation. He also said he walks poorly and has difficulty working. The American Hospital Association said it does not have a specific policy governing immigrant removals, and it does not track how many hospitals encounter the issue.

Lack of regulations

The American Medical Association’s Council on Ethical and Judicial Affairs issued a strongly worded directive to doctors in 2009, urging them not to “allow hospital administrators to use their significant power and the current lack of regulations” to send patients to other countries.

Doctors cannot expect hospitals to provide costly uncompensated care to patients indefinitely, the statement said. “But neither should physicians allow hospitals to arbitrarily determine the fate of an uninsured noncitizen immigrant patient." — AP


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