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For patient, time runs out
A nursing home pays to return an illegal immigrant to his homeland, saying it cannot afford to keep him
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By Colleen Mastony
Tribune staff reporter

November 9, 2005

Next to his bed, Orlando Lopez keeps a cardboard box containing stacks of bills he has been unable to pay. Since a stroke four years ago left him partially paralyzed, the Filipino has lived in a Des Plaines nursing home, relearning how to talk, brush his teeth, button his pants.

At 43, he has mild brain damage. He has no money, no insurance and, as an undocumented immigrant, no legal right to be here.

Officials at Ballard Healthcare nursing home, who have been caring for Lopez for free, have bought him a $700 plane ticket. On Wednesday, they will send him back to the Philippines.

Ballard officials say it is their only choice. Because Lopez is here illegally, he does not qualify for Medicaid. He has no family in the U.S., and no other nursing home will take him.

All told, Lopez owes the nursing home $263,000. His case illustrates the lack of options for undocumented immigrants who suffer debilitating injuries in the United States and the frustration of health-care facilities that must pick up the costs of their long-term care.

"I feel sad because I am leaving America," said Lopez, who goes by the nickname Felix. "In this kind of situation, even if I can be legalized, I cannot work. In the Philippines, I have people to help me."

The federal Emergency Medical Treatment and Active Labor Act requires hospitals to provide emergency care to people regardless of insurance or immigration status. Medicaid, the joint federal-state program that finances health care for the poor, covers the cost of treating undocumented immigrants who arrive with injuries in emergency rooms.

But neither Medicaid nor the federal law makes any stipulation for long-term care. And because hospitals and nursing homes cannot release debilitated patients without a place to send them, the facilities in some cases have no option but to keep the patients and absorb the costs.

Faced with this dilemma, a handful of hospitals and nursing homes around the nation have paid to fly undocumented patients back to their home countries. In 2002, a Nebraska hospital flew a car accident victim back to Mexico after the patient's care had reached $1 million. The following year, a Florida hospital chartered a medical plane and sent a patient to Guatemala after he had run up a bill of $2 million.

The cases are unusual because the hospitals themselves have picked up the cost of the flights. Usually, U.S. hospitals and nursing homes work with a foreign consulate to find family members, locate hospitals abroad and arrange for travel. The family members, and sometimes the consulates, typically pay for plane tickets and transportation.

`It is costing us $200 a day'

At Ballard, officials said they cannot afford to keep Lopez. "Right now, it is costing us $200 a day," said Jack Dudeck, Ballard's operations administrator.

No one knows how often undocumented immigrants are sent back to their home countries after debilitating illnesses or injuries. The issue seems to fall into a bureaucratic gray area in which no government agency claims jurisdiction.

The Illinois Department of Public Health considers the cases federal domain. U.S. Immigration and Customs Enforcement officials do not step in because the cases typically do not involve a crime or a deportation order. Likewise, Centers for Medicare & Medicaid Services, the federal regulatory agency that oversees health care for the poor, and the State Department, take a hands-off approach.

The problem is so vexing that Terrence Sullivan, executive director of the Illinois Council on Long Term Care, warns facilities to be careful about whom they admit.

"Most nursing homes will ask the question: `Is this a citizen?' If you fail to ask the question, you could end up with a patient who is not going to be covered," Sullivan said.

The Mexican Consulate in Chicago helps arrange to send about two sick or injured Mexican nationals back home every month. "They are very sad cases for us," said Raul Garcia, a consulate official who specializes in health care. "There is nothing we can do. We urge them to go back to Mexico. But most do not want to go."

Like so many others, Lopez did not want to return to the Philippines. In 1994, he came to the U.S. to find a better life. He had grown up in a small town in Bataan province and had lived with his parents in a one-room house where family members slept on the floor.

He says he paid an agency in the Philippines for false travel documents, flew to San Francisco and made his way to Chicago. Lopez bought a false name and Social Security number so he could apply for work. He got a job delivering room service at the Hilton Hotel at O'Hare International Airport. Every month, he sent $200 to his parents.

Lopez had been living in Chicago for nearly eight years when he had a stroke at a shopping mall in fall 2001. He remembers feeling dizzy and falling. He saw the faces of other shoppers gathered around him. His vision grew dark, then he blacked out.

After emergency treatment at Loyola University Medical Center and Kindred Hospital, Lopez went to Ballard for rehabilitation.

When he first arrived, he couldn't move except to occasionally wiggle his right thumb. The stroke left him with mild to moderate brain damage and paralysis on his left side.

At the time of Lopez's admission, Ballard officials said they did not know he was undocumented. But when they tried to verify his identification and Social Security number, they found that he was in the country illegally.

Lopez said that as his medical bills ballooned, nursing home officials began urging him to find another place to stay. They knew he had siblings in the Philippines; a sister had flown in to visit him after the accident.

"We sent letters. We called," said Eli Pick, the executive director of Ballard. "Obviously, they did not want to talk to us."

Therapy discontinued

After three years of rehab, Lopez had regained some of his speech and learned to use a walker. Last year nursing home officials discontinued his therapy because his progress had reached a plateau, they said. In October, the nursing home sent him a letter explaining that because he had not paid his bill, they would have to discharge him within 30 days.

The Illinois Nursing Home Care Act allows facilities to release patients who have not paid their bills. A nursing home must issue a notice of involuntary discharge, which a patient has the right to appeal. The discharge order must include a place to send the patient. Lopez's discharge papers listed the Consulate General of the Philippines in Chicago, an office on Michigan Avenue, as his placement.

When Lopez asked nursing home officials what would happen if he refused to leave, they told him they would call the police. After the 30-day notice, "he has no right or reason to be here," said Pick.

Because Lopez' condition had stabilized, Ballard officials said they felt they could release him. They considered sending to a homeless shelter or rooming house. But, Pick said, "we felt in good conscience we couldn't do that."

After nursing home officials mentioned calling police, Lopez phoned his 76-year-old mother, who cried and told him to come home.

Lopez expects to leave Wednesday. A member of a local church has volunteered to escort him home.

The nursing home will send him with two weeks' worth of medicine. Pick said the consulate has arranged for medical care in the Philippines, and a state agency will provide medicine.

Lopez will live with his mother. Other friends and relatives live nearby in case he needs help. But as he prepares to leave, the medical bills continue to arrive.

"I open them," he said. "I put them in the box."